Wortham Jonathan M, Hansen Nellie I, Schrag Stephanie J, Hale Ellen, Van Meurs Krisa, Sánchez Pablo J, Cantey Joseph B, Faix Roger, Poindexter Brenda, Goldberg Ronald, Bizzarro Matthew, Frantz Ivan, Das Abhik, Benitz William E, Shane Andi L, Higgins Rosemary, Stoll Barbara J
Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia
Social, Statistical, and Environmental Sciences, RTI International, Research Triangle Park, North Carolina;
Pediatrics. 2016 Jan;137(1). doi: 10.1542/peds.2015-2323. Epub 2015 Dec 30.
Current guidelines for prevention of neonatal group B streptococcal disease recommend diagnostic evaluations and empirical antibiotic therapy for well-appearing, chorioamnionitis-exposed newborns. Some clinicians question these recommendations, citing the decline in early-onset group B streptococcal disease rates since widespread intrapartum antibiotic prophylaxis implementation and potential antibiotic risks. We aimed to determine whether chorioamnionitis-exposed newborns with culture-confirmed, early-onset infections can be asymptomatic at birth.
Multicenter, prospective surveillance for early-onset neonatal infections was conducted during 2006-2009. Early-onset infection was defined as isolation of a pathogen from blood or cerebrospinal fluid collected ≤ 72 hours after birth. Maternal chorioamnionitis was defined by clinical diagnosis in the medical record or by histologic diagnosis by placental pathology. Hospital records of newborns with early-onset infections born to mothers with chorioamnionitis were reviewed retrospectively to determine symptom onset.
Early-onset infections were diagnosed in 389 of 396,586 live births, including 232 (60%) chorioamnionitis-exposed newborns. Records for 229 were reviewed; 29 (13%) had no documented symptoms within 6 hours of birth, including 21 (9%) who remained asymptomatic at 72 hours. Intrapartum antibiotic prophylaxis exposure did not differ significantly between asymptomatic and symptomatic infants (76% vs 69%; P = .52). Assuming complete guideline implementation, we estimated that 60 to 1400 newborns would receive diagnostic evaluations and antibiotics for each infected asymptomatic newborn, depending on chorioamnionitis prevalence.
Some infants born to mothers with chorioamnionitis may have no signs of sepsis at birth despite having culture-confirmed infections. Implementation of current clinical guidelines may result in early diagnosis, but large numbers of uninfected asymptomatic infants would be treated.
目前预防新生儿B族链球菌病的指南建议，对外观良好、有绒毛膜羊膜炎接触史的新生儿进行诊断评估和经验性抗生素治疗。一些临床医生对这些建议提出质疑，理由是自广泛实施产时抗生素预防以来，早发性B族链球菌病的发病率有所下降，以及潜在的抗生素风险。我们旨在确定有绒毛膜羊膜炎接触史、经培养确诊为早发性感染的新生儿在出生时是否可以无症状。
2006年至2009年期间进行了多中心前瞻性早发性新生儿感染监测。早发性感染定义为出生后≤72小时采集的血液或脑脊液中分离出病原体。产妇绒毛膜羊膜炎通过病历中的临床诊断或胎盘病理组织学诊断来定义。对有绒毛膜羊膜炎的母亲所生早发性感染新生儿的医院记录进行回顾性审查，以确定症状发作情况。
在396586例活产中，有389例诊断为早发性感染，其中232例（60%）为有绒毛膜羊膜炎接触史的新生儿。对229例的记录进行了审查；29例（13%）在出生后6小时内无记录的症状，其中21例（9%）在72小时时仍无症状。无症状和有症状婴儿的产时抗生素预防暴露情况无显著差异（76%对69%；P = 0.52）。假设完全实施指南，我们估计，根据绒毛膜羊膜炎的患病率，每例感染无症状新生儿将有60至1400例新生儿接受诊断评估和抗生素治疗。
一些有绒毛膜羊膜炎的母亲所生的婴儿，尽管经培养确诊感染，但出生时可能没有败血症迹象。实施当前临床指南可能会导致早期诊断，但大量未感染的无症状婴儿将接受治疗。
