Lin Feng Ying C, Troendle James F
Division of Epidemiology, Statistics and Prevention Research, National Institute of Child Health and Human Development, National Institutes of Health, Department of Health and Human Services, Bethesda, MD 20892, USA.
Pediatr Infect Dis J. 2006 Oct;25(10):884-8. doi: 10.1097/01.inf.0000239322.58890.94.
Phospholipids from the group B streptococcal (GBS) cell wall cause pulmonary hypertension in experimental animals. When exposed to penicillin, Streptococcus mutans releases phospholipids immediately. We hypothesize that newborns colonized with GBS receive bacterial phospholipids leading to pulmonary hypertension and respiratory distress, especially in the situation of newborns of penicillin-treated mothers. We examined clinical and epidemiologic data on these relations.
We used data from a prospective multicenter GBS study conducted from 1995 to 1999 in which 1674 of 17,690 newborns cultured at 4 sites were colonized with GBS. Our analyses included 1610 colonized newborns > or =32 weeks gestation without early-onset disease. Clinical features were compared between 1003 lightly colonized (GBS positive at < or =2 sites) and 607 heavily colonized (positive at 3 or 4 sites) newborns. The rates of respiratory distress were compared between colonized newborns of penicillin-treated mothers and those of untreated mothers.
Of the 1610 colonized newborns, 8.8% had signs of respiratory distress within 48 hours after birth (cases). Oxygen supplementation was used in 60% of the cases, mechanical ventilation was required in 5% and persistent pulmonary hypertension was diagnosed in 2%. Compared with light colonization, heavy colonization increased the rate of respiratory distress 1.73-fold (95% CI, 1.26-2.38), a discharge diagnosis of respiratory disorder 2.02-fold (95% CI, 1.16-3.52), a blood/cerebrospinal fluid obtained for culture 1.54-fold (95% CI, 1.24-1.93) and antibiotic administration after birth 1.87-fold (95% CI, 1.34-2.61). Penicillin use during labor was associated with a 2.62-fold (95% CI, 1.79-3.83) increase in respiratory distress in the colonized newborn.
Our findings support the association of neonatal respiratory distress with asymptomatic GBS colonization and with penicillin use during labor. These data require confirmation.
B族链球菌（GBS）细胞壁中的磷脂可导致实验动物发生肺动脉高压。变形链球菌在接触青霉素时会立即释放磷脂。我们推测，定植有GBS的新生儿会接触到细菌磷脂，从而导致肺动脉高压和呼吸窘迫，尤其是在母亲接受青霉素治疗的新生儿中。我们研究了这些关系的临床和流行病学数据。
我们使用了1995年至1999年进行的一项前瞻性多中心GBS研究的数据，在4个地点培养的17690例新生儿中，有1674例定植有GBS。我们的分析纳入了1610例胎龄≥32周且无早发型疾病的定植新生儿。比较了1003例轻度定植（GBS在≤2个部位呈阳性）和607例重度定植（GBS在3个或4个部位呈阳性）新生儿的临床特征。比较了母亲接受青霉素治疗的定植新生儿和未接受治疗的定植新生儿的呼吸窘迫发生率。
在1610例定植新生儿中，8.8%在出生后48小时内出现呼吸窘迫体征（病例）。60%的病例需要吸氧，5%的病例需要机械通气，2%的病例被诊断为持续性肺动脉高压。与轻度定植相比，重度定植使呼吸窘迫发生率增加1.73倍（95%CI，1.26-2.38），出院诊断为呼吸障碍的发生率增加2.02倍（95%CI，1.16-3.52），获取血样/脑脊液进行培养的发生率增加1.54倍（95%CI，1.24-1.93），出生后使用抗生素的发生率增加1.87倍（95%CI，1.34-2.61）。分娩期间使用青霉素与定植新生儿呼吸窘迫发生率增加2.62倍（95%CI，1.79-3.83）相关。
我们的研究结果支持新生儿呼吸窘迫与无症状GBS定植以及分娩期间使用青霉素之间的关联。这些数据需要进一步证实。
