并非所有患有临床绒毛膜羊膜炎的母亲所生的新生儿都需要治疗。
Not all newborns born to mothers with clinical chorioamnionitis need to be treated.
机构信息
Department of Neonatology, Kaplan Medical Center, Hebrew University of Jerusalem, Rehovot, Israel.
Department of Pediatrics, Kaplan Medical Center, Hebrew University of Jerusalem, Rehovot, Israel.
出版信息
J Matern Fetal Neonatal Med. 2021 Jun;34(12):1949-1954. doi: 10.1080/14767058.2019.1651281. Epub 2019 Aug 13.
PURPOSE
The 2010 recommendations of the Centers for Disease Control and Prevention (CDC) for prevention of perinatal group B Streptococcal Disease (GBS) is that symptomatic newborns suspect for early onset sepsis (EOS), or newborns born to mothers with clinical chorioamnionitis should receive antibiotic treatment. Our protocol was changed accordingly during 2015. We prospectively assessed the safety of the protocol and evaluated the need to treat all newborns born to mothers with clinical chorioamnionitis and retrospectively evaluated the performance of the EOS risk calculator.
METHODS
The study period was from May 2015 to April 2016 at the Kaplan Medical Center (KMC). Inclusion criteria were: gestational age of 35 weeks and above, newborns that were treated with antibiotic, newborn born to mothers with risk factors for EOS or with maternal clinical chorioamnionitis, or to mothers that were given intra-partum antibiotic prophylaxis (IAP).
RESULTS
In the study period, 7058 newborns were born, 1341 (19%) neonates were included according to the inclusion criteria. Six newborns had EOS (0.85 per 1000 live born). 123/1341 (9%) of the neonates were symptomatic of whom six (4.9%) had proven EOS with RR 10.9 (CI 3.5-33.39, < .0001), NNT was 22.6. Of them, 89/1341 (6.6%) were treated for maternal clinical chorioamnionitis, two (2.25%) had proven EOS, but they were also symptomatic. The RR was 5.03 (CI 1.03-24.6 = .045) and the NNT was 55.5. Symptomatic newborns were at an increased risk of 2.2 to have EOS compared with newborns with maternal clinical chorioamnionitis. During the study period, 201 (15%) newborns received antibiotic treatment, while if we had only used the calculator, 111 (8%) newborns would have been treated (<.001). Only one (out of three with maternal risk factors) newborn was symptomatic during the first hour of life. Three of the mothers whose newborn developed EOS, had no risk factors so there was no need for the calculator. The calculated EOS risk at birth for the other three ranged from 0.37 to 0.67.
CONCLUSIONS
We suggest that asymptomatic newborns born to mothers with clinical chorioamnionitis should not receive antibiotic treatment automatically.
目的
疾病控制与预防中心（CDC）2010 年针对预防围产期 B 组链球菌病（GBS）的建议是，有症状的疑似早发型败血症（EOS）的新生儿，或母亲患有临床绒毛膜羊膜炎的新生儿，应接受抗生素治疗。我们的方案在 2015 年进行了相应的修改。我们前瞻性地评估了该方案的安全性，并评估了是否需要对所有患有临床绒毛膜羊膜炎的母亲所生的新生儿进行治疗，并回顾性地评估了 EOS 风险计算器的性能。
方法
研究期间为 2015 年 5 月至 2016 年 4 月在卡普兰医疗中心（KMC）进行。纳入标准为：胎龄 35 周及以上，接受抗生素治疗的新生儿，有 EOS 危险因素的母亲所生的新生儿或母亲有临床绒毛膜羊膜炎，或母亲接受了产时抗生素预防（IAP）。
结果
在研究期间，有 7058 名新生儿出生，根据纳入标准，有 1341 名（19%）新生儿符合条件。6 名新生儿患有 EOS（每 1000 例活产 0.85 例）。1341 名中有 123 名（9%）新生儿出现症状，其中 6 名（4.9%）经证实为 EOS，RR 为 10.9（CI 3.5-33.39，<.0001），NNT 为 22.6。其中，89/1341（6.6%）因母亲临床绒毛膜羊膜炎接受治疗，2 名（2.25%）患有 EOS，但也有症状。RR 为 5.03（CI 1.03-24.6=.045），NNT 为 55.5。有症状的新生儿患 EOS 的风险比有母亲临床绒毛膜羊膜炎的新生儿高 2.2 倍。在研究期间，有 201 名（15%）新生儿接受了抗生素治疗，而如果我们只使用计算器，将有 111 名（8%）新生儿需要治疗（<.001）。只有一名（3 名有母亲危险因素的新生儿之一）在生命的第一个小时出现症状。EOS 患儿的 3 名母亲没有危险因素，因此无需使用计算器。另外 3 名患儿的 EOS 风险在出生时计算值为 0.37 至 0.67。
结论
我们建议，不应自动对患有临床绒毛膜羊膜炎的母亲所生的无症状新生儿进行抗生素治疗。
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