Roos R
Monatsschr Kinderheilkd (1902). 1978 Sep;126(9):540-8.
Nowadays, in severe infections during the neonatal period new bacteria--group B streptococci--have to be taken into account, since in some clinics they already predominate over gramnegative rods. Septicemia and meningitis may be caused by group B streptococci. The septicemia which especially threatents prematures starts with apnoeic spells in the very first hours after birth and may be easily misdiagnosed as an idiopathic respiratory distress syndrome. The mortality is very high (about 60%). Meningitis starts later, normally during the 3rd to 4th week. Seizures are typical at the onset. Group B streptococci may be identified in the CSF by counterimmunoelectrophoresis within one hour. The prognosis is more favourable in meningitis than in septicemia (mortality about 20%). Survivors have little neurological sequelae. Penicillin G or ampicillin combination with an aminoglycoside is recommended as chemotherapy. Exchange transfusion should be considered early. Group B streptococci causing the septic form may be transfered during labour since up to 25% of pregnant women are colonized. Nosocomial transmission of group B streptococci may be the reason for meningitis. Prophylactic penicillin does not seem to help in preventing the disease, but it is possible, that meningitis of the newborn may be prevented by immunizing the mother during pregnancy.
如今,在新生儿期的严重感染中,必须考虑一种新的细菌——B族链球菌,因为在一些诊所中,它们已经超过革兰氏阴性杆菌占据主导地位。败血症和脑膜炎可能由B族链球菌引起。特别威胁早产儿的败血症在出生后的最初几个小时以呼吸暂停发作开始,很容易被误诊为特发性呼吸窘迫综合征。死亡率非常高(约60%)。脑膜炎发病较晚,通常在第3至4周。发病时癫痫发作很典型。通过对流免疫电泳可在一小时内在脑脊液中鉴定出B族链球菌。脑膜炎的预后比败血症更有利(死亡率约20%)。幸存者几乎没有神经后遗症。推荐使用青霉素G或氨苄青霉素与一种氨基糖苷类药物联合作为化疗药物。应尽早考虑进行换血治疗。引起败血症的B族链球菌可能在分娩过程中传播,因为高达25%的孕妇携带该菌。B族链球菌的医院内传播可能是脑膜炎的原因。预防性使用青霉素似乎无助于预防该病,但通过在孕期给母亲接种疫苗有可能预防新生儿脑膜炎。