Borchardt Stephanie M, Kocharian Anna, Hopfensperger Daniel, Davis Jeffrey P
WMJ. 2016 Apr;115(2):74-9; quiz 80.
To evaluate the completeness of identification of pregnant women testing positive for hepatitis B surface antigen (HBsAg) and birth dose hepatitis B vaccine administration, and the extent of appropriate prophylaxis of infants born to women with and without maternal HBsAg status documented in the infant medical record.
We conducted medical record reviews of 3058 maternal and infant pairs at 58 Wisconsin maternity hospitals that cumulatively delivered 90% of Wisconsin's 2010 birth cohort.
A documented HBsAg test result for the current pregnancy was included in 2928 (95.7%) of maternal records, and in 2676 (87.5%) infant records. Four infants (15%) were born to HBsAg-positive women; all 4 infants received appropriate prophylaxis: hepatitis B immunoglobulin (HBIG) and a dose of hepatitis B vaccine within 12 hours of birth. However, among 382 infants without a documented maternal HBsAg test result in the infant medical record, only 135 (35%) received appropriate prophylaxis: a dose of hepatitis B vaccine within 12 hours of birth or a dose of hepatitis B vaccine and HBIG within 12 hours of birth for infants weighing < 2000 g. Among all infants, 81.6% received hepatitis B vaccine prior to hospital discharge.
Hospitals must ensure that infants without a documented maternal HBsAg test result receive appropriate prophylaxis to prevent hepatitis B vaccine infection. All infants, regardless of maternal HBsAg test result, should receive a dose of hepatitis B vaccine before hospital discharge to serve as a "safety net" to prevent infection among infants born to HBsAg-positive women who are not identified prenatally. A written hospital policy for universal hepatitis B vaccine birth dose administration should be developed to reinforce admission orders.
评估乙肝表面抗原（HBsAg）检测呈阳性的孕妇的识别完整性以及出生剂量乙肝疫苗的接种情况，以及在婴儿病历中有或无母亲HBsAg状态记录的情况下，对其所生婴儿进行适当预防的程度。
我们对威斯康星州58家妇产医院的3058对母婴进行了病历审查，这些医院累计接生了威斯康星州2010年出生队列的90%。
2928份（95.7%）母亲病历和2676份（87.5%）婴儿病历中包含了本次妊娠的HBsAg检测结果记录。4名婴儿（15%）的母亲HBsAg呈阳性；这4名婴儿均接受了适当的预防措施：乙肝免疫球蛋白（HBIG）以及出生后12小时内接种一剂乙肝疫苗。然而，在382名婴儿病历中无母亲HBsAg检测结果记录的婴儿中，只有135名（35%）接受了适当的预防措施：出生后12小时内接种一剂乙肝疫苗，或出生体重<2000g的婴儿在出生后12小时内接种一剂乙肝疫苗和HBIG。在所有婴儿中，81.6%在出院前接种了乙肝疫苗。
医院必须确保没有母亲HBsAg检测结果记录的婴儿接受适当的预防措施以预防乙肝感染。所有婴儿，无论母亲HBsAg检测结果如何，都应在出院前接种一剂乙肝疫苗，作为一种“安全网”，以预防未在产前被识别的HBsAg阳性母亲所生婴儿的感染。应制定一项关于普遍接种出生剂量乙肝疫苗的医院书面政策，以强化入院医嘱。
