Wolf H, Schaap A H, Smit B J, Spanjaard L, Adriaanse A H
Department of Obstetrics and Gynecology, Academic Medical Center, Amsterdam, The Netherlands.
Infect Dis Obstet Gynecol. 2000;8(3-4):143-50. doi: 10.1155/S1064744900000181.
Comparison of the incidence and case fatality of early-onset group B streptococcus sepsis and sepsis caused by other pathogens in neonates after change of management of intrauterine infection.
All infants delivered from 1988 through 1997 at a gestational age > or = 24 weeks with a birth weight > or = 500 gram without lethal congenital abnormalities were eligible for inclusion. Infants delivered by cesarean section before the onset of labor or rupture of membranes were excluded. During the first period (1988-1991) intrauterine infection was diagnosed by a temperature > 38 degrees C, during the second period (1992-1997) this diagnosis was made at a lower temperature (> or = 37.8 degrees C) or by fetal tachycardia > or = 160/min. Treatment of intrauterine infection was similar during both periods with 3 x 2 gram amoxicillin and 1 x 240 mg gentamicin every 24 hours intravenously during labor. Prophylactic treatment during labor was only given to women with a history of an earlier infant with early-onset group B streptococcus sepsis.
During the first period 6,103 infants were included, during the second period 8,504. Intrauterine infection was diagnosed and treated more often in the second period (7.1% vs. 2.6%). The incidence of early-onset group B streptococcus sepsis was significantly lower in the second period than in the first period [0.2% vs. 0.4%; OR 0.5 (0.3-0.9)] and survival without disability higher [80% vs. 52%; OR 4.5 (1.4-16.5)]. However, in both periods the overall incidence of neonatal sepsis (3.6% vs. 3.5%) and overall mortality because of sepsis (14.3% vs.13.1%) were similar.
Although the early detection of clinical signs of intrauterine infection might have been effective for the prevention of serious sequelae of early-onset group B streptococcus sepsis the overall incidence and mortality from neonatal sepsis remained unchanged. Evaluation of preventive measures for early-onset group B streptococcus sepsis should always take the incidence of neonatal sepsis caused by other pathogens into account.
比较宫内感染管理改变后新生儿早发型B族链球菌败血症及其他病原体所致败血症的发病率和病死率。
纳入1988年至1997年期间孕周≥24周、出生体重≥500克且无致命先天性异常的所有婴儿。排除在临产或胎膜破裂前剖宫产分娩的婴儿。在第一阶段（1988 - 1991年），宫内感染通过体温>38℃诊断，在第二阶段（1992 - 1997年），该诊断依据较低体温（≥37.8℃）或胎儿心动过速≥160次/分钟做出。两个阶段宫内感染的治疗相似，分娩期间每24小时静脉注射3×2克阿莫西林和1×240毫克庆大霉素。仅对有早发型B族链球菌败血症患儿病史的产妇在分娩期间进行预防性治疗。
第一阶段纳入6103例婴儿，第二阶段纳入8504例。第二阶段宫内感染的诊断和治疗更为频繁（7.1%对2.6%）。第二阶段早发型B族链球菌败血症的发病率显著低于第一阶段[0.2%对0.4%；比值比0.5（0.3 - 0.9）]，无残疾存活者比例更高[80%对52%；比值比4.5（1.4 - 16.5）]。然而，两个阶段新生儿败血症的总体发病率（3.6%对3.5%）和败血症所致总体死亡率（14.3%对13.1%）相似。
尽管早期发现宫内感染的临床体征可能对预防早发型B族链球菌败血症的严重后遗症有效，但新生儿败血症的总体发病率和死亡率仍未改变。评估早发型B族链球菌败血症的预防措施时应始终考虑其他病原体所致新生儿败血症的发病率。
