Adair Carol Elaine, Kowalsky Laura, Quon Harvey, Ma Doreen, Stoffman Jayson, McGeer Allison, Robertson Sheila, Mucenski Melissa, Davies H Dele
Child Health Research Unit, Alberta Children's Hospital, Calgary, Alta.
CMAJ. 2003 Aug 5;169(3):198-203.
Infection with group B streptococcus (GBS) is a major cause of neonatal illness and death. We examined the antenatal and perinatal risk factors for early-onset GBS disease among neonates.
We identified cases by population-based surveillance in all microbiology laboratories serving Alberta. A case was defined as any instance of a positive sterile-site GBS culture in an infant born between 1993 and 1997 who was either less than 7 days old or stillborn after 20 weeks' gestation. We randomly selected controls from a computer-compiled list of all hospital births, including stillbirths after 20 weeks' gestation, in Alberta during the study period. To increase power, we chose 5 or 6 control infants born in the same year as each case infant. We reviewed hospital, prenatal clinic and physician health records and, between 1997 and 1999, conducted maternal interviews by telephone.
There were no differences between the 90 cases and 489 controls in sociodemographic variables or in many reproductive and behavioural variables. Case infants were more likely than control infants to be of low birth weight (odds ratio [OR] 3.60, 95% confidence interval [CI] 1.68-7.65), to have been delivered preterm (OR 3.89, 95% CI 2.08-7.27), or to have a mother with amnionitis (OR 15.03, 95% CI 5.58-41.89), intrapartum fever (OR 4.65, 95% CI 2.48-8.69) or premature rupture of the membranes (OR 2.39, 95% CI 1.38-4.14). After adjustment for potential confounders, intrauterine fetal monitoring was associated with a more than 2-fold increase in the risk of neonatal GBS disease (OR 2.24, 95% CI 1.22-4.13).
Intrauterine fetal monitoring should be added to the list of risk factors in risk-based screening. Since many of the cases had no identifiable maternal risk factors, universal screening for GBS may be appropriate.
B族链球菌（GBS）感染是新生儿疾病和死亡的主要原因。我们研究了新生儿早发型GBS疾病的产前和围产期危险因素。
我们通过对艾伯塔省所有微生物实验室进行基于人群的监测来确定病例。病例定义为1993年至1997年间出生的婴儿，出生时小于7天或妊娠20周后死产，且无菌部位GBS培养呈阳性的任何情况。我们从研究期间艾伯塔省所有医院分娩（包括妊娠20周后的死产）的计算机编制列表中随机选择对照。为了提高检验效能，我们为每个病例婴儿选择同年出生的5或6名对照婴儿。我们查阅了医院、产前诊所和医生的健康记录，并在1997年至1999年间通过电话对母亲进行了访谈。
90例病例和489名对照在社会人口统计学变量或许多生殖和行为变量方面没有差异。病例婴儿比对照婴儿更有可能出生体重低（比值比[OR]3.60，95%置信区间[CI]1.68 - 7.65）、早产（OR 3.89，95% CI 2.08 - 7.27），或其母亲患有羊膜炎（OR 15.03，95% CI 5.58 - 41.89）、产时发热（OR 4.65，95% CI 2.48 - 8.69）或胎膜早破（OR 2.39，95% CI 1.38 - 4.14）。在对潜在混杂因素进行调整后，宫内胎儿监测与新生儿GBS疾病风险增加2倍以上相关（OR 2.24，95% CI 1.22 - 4.13）。
基于风险的筛查中的危险因素列表应增加宫内胎儿监测。由于许多病例没有可识别的母亲危险因素，对GBS进行普遍筛查可能是合适的。
