Ablow R C, Driscoll S G, Effmann E L, Gross I, Jolles C J, Uauy R, Warshaw J B
N Engl J Med. 1976 Jan 8;294(2):65-70. doi: 10.1056/NEJM197601082940201.
In attempting to differentiate early-onset Group B streptococcal infection from hyaline-membrane disease we found features of severe Group B infection to be rupture of the membranes for more than 12 hours before delivery (four or eight versus one of nine), gram-positive cocci in the gastric aspirate (four or four versus none of one), apnea and shock in the first 24 hours of life (seven of eight versus none of nine), and the generation of lower peak inspiratory pressures on avolume-cycled respirator (mean of 36.5 +/- 2.8 versus 63.9 +/- 6.2 cm of water; P = 0.005). In eight fatal cases of Group B infection, four patients had radiographic features indistinguishable from hyaline-membrane disease whereas the other cases were consistent with neonatal pneumonia. Seven of the eight infected infants had no histologic evidence of coexisting hyaline-membrane disease. Microscopical features of Group B infection included cocci in unevenly distributed hyaline membranes and minimal atelectasis. Group B streptococcal infection differs clinically and pathologically from hyaline-membrane disease. Differentiating clinical features include early apnea and shock and lower inspiratory pressures on mechanical ventilation.
在试图区分早发型B族链球菌感染与透明膜病时，我们发现严重B族感染的特征为：分娩前胎膜破裂超过12小时（8例中的4例或4例对比9例中的1例）、胃吸出物中有革兰氏阳性球菌（4例中的4例对比1例中的无）、出生后24小时内出现呼吸暂停和休克（8例中的7例对比9例中的无），以及在容量控制呼吸机上产生较低的吸气峰压（平均为36.5±2.8对比63.9±6.2厘米水柱；P = 0.005）。在8例B族感染的致命病例中，4例患者的影像学特征与透明膜病无法区分，而其他病例符合新生儿肺炎。8例感染婴儿中有7例没有并存透明膜病的组织学证据。B族感染的显微镜特征包括在分布不均匀的透明膜中有球菌和轻度肺不张。B族链球菌感染在临床和病理上与透明膜病不同。鉴别临床特征包括早期呼吸暂停和休克以及机械通气时较低的吸气压力。
