Trotman H, Bell Y
Department of Obstetrics, Gynaecology and Child Health, University of the West Indies, Mona, Jamaica.
Ann Trop Paediatr. 2006 Mar;26(1):53-7. doi: 10.1179/146532806X90619.
To describe the incidence, clinical presentation and outcome of neonatal group B streptococcal (GBS) infection at the University Hospital of the West Indies (UHWI).
A 10-year retrospective review of all inborn neonates admitted to the neonatal unit of UHWI with GBS infection between 1 January 1991 and 31 December 2000 was conducted. Differences in maternal and neonatal characteristics between early- and late-onset disease (EOD, LOD) were determined.
There were 32,029 live births and 29 neonates were admitted for GBS infection, an incidence of 0.91/1000 live births (95% CI 0.58-1.23/1000). Twenty-one (72%) neonates had EOD, a rate of 0.66/1000 live births (95% CI 0.38-0.94/1000) and eight (28%) had LOD, a rate of 0.23/1000 (95% CI 0.08-0.42/1000). Seventeen of the 21 (81%) cases of EOD occurred within the 1st 24 hours of life. The most common clinical diagnosis was septicaemia (17, 61%), followed by pneumonia (8, 28%) and meningitis (3, 11%). All five (100%) babies whose mothers' membranes were ruptured for >18 hours had EOD. The babies of all six (100%) women with intrapartum pyrexia went on to have EOD. A greater proportion of babies (63%) with LOD were preterm and of low birthweight. The most common presenting symptom was respiratory distress which occurred more frequently in neonates with EOD, p=0.006. One neonate died, giving a case fatality rate of 3.6%.
Although the incidence of GBS infection is relatively low at UHWI, further reduction in the incidence might be achieved by implementation of measures to prevent perinatal transmission.
描述西印度群岛大学医院(UHWI)新生儿B族链球菌(GBS)感染的发病率、临床表现及转归。
对1991年1月1日至2000年12月31日期间入住UHWI新生儿病房的所有患GBS感染的出生时即有的新生儿进行了为期10年的回顾性研究。确定早发型和晚发型疾病(EOD、LOD)在母亲和新生儿特征方面的差异。
共有32029例活产,29例新生儿因GBS感染入院,发病率为0.91/1000活产(95%可信区间0.58 - 1.23/1000)。21例(72%)新生儿为早发型疾病,发病率为0.66/1000活产(95%可信区间0.38 - 0.94/1000),8例(28%)为晚发型疾病,发病率为0.23/1000(95%可信区间0.08 - 0.42/1000)。21例早发型疾病病例中的17例(81%)发生在出生后24小时内。最常见的临床诊断是败血症(17例,61%),其次是肺炎(8例,28%)和脑膜炎(3例,11%)。母亲胎膜破裂超过18小时的所有5例(100%)婴儿均为早发型疾病。所有6例(100%)产时发热妇女的婴儿均发生早发型疾病。晚发型疾病的婴儿中更大比例(63%)为早产儿和低体重儿。最常见的表现症状是呼吸窘迫,在早发型疾病新生儿中更频繁出现,p = 0.006。1例新生儿死亡,病死率为3.6%。
尽管UHWI的GBS感染发病率相对较低,但通过实施预防围产期传播的措施可能进一步降低发病率。