Neonatal Intensive Care Unit, Women's Wellness and Research Center, Hamad Medical Corporation, Doha, Qatar.
Pediatric Department, Weill Cornell Medicine, Doha, Qatar.
BMC Pediatr. 2024 Aug 15;24(1):526. doi: 10.1186/s12887-024-04980-z.
Early-onset neonatal sepsis (EONS) significantly impacts neonatal morbidity and mortality, with maternal bacteremia during the peripartum period being a potential risk factor. This study aims to explore the association between peripartum maternal bacteremia and EONS.
A retrospective cohort study at the Women's Wellness and Research Center in Doha, Qatar (2015-2019) compared women with and without bacteremia, based on blood cultures taken from up to seven days before to 48 h after delivery, examining the association with EONS.
Among the 536 maternal blood cultures analyzed, 102 (19.0%) were positive. The most prevalent organisms were Group B streptococcus (GBS) (39.2%), followed by Escherichia coli (14.7%) and anaerobes (10.8%). Neonates from bacteremic mothers had lower birth weights (2913 ± 86 g vs. 3140 ± 745 g; MD 227.63 g; 95% CI 61.72 - 393.55; p = 0.007), required more resuscitation (27.5% vs. 13.2%; OR 2.48; 95% CI 1.48 - 4.17; p < 0.001), and received antibiotics for ≥ 7 days more frequently (41.2% vs. 16.6%; OR 3.51; 95% CI 2.20 - 5.62; p < 0.001) compared to those from non-bacteremic mothers. Maternal Gram-positive (GP) organisms were more commonly isolated in term gestation (67.9%) compared to Gram-negative (GN) (22.2%) and anaerobic bacteremias (9.9%). During intrapartum, GP bacteremia was predominant (67.1%) vs. GN (21.4%) and Anaerobes (11.4%), with GN bacteremia being more common in postpartum samples. Culture-proven EONS occurred in 0.75% of the cohort, affecting 3.9% of infants from bacteremic mothers vs. none in controls (OR 2.34; 95% CI 1.27 - 4.31; p < 0.001). Culture-negative EONS appeared in 14.7% of infants from bacteremic mothers vs. 7.8% in controls (OR 2.02; 95% CI, 1.05 - 3.88; p = 0.03). Among 40 cases of maternal GBS bacteremia, culture-proven GBS EONS occurred in 3 neonates (7.5%), all from mothers with negative GBS screening, compared to none in the control group. A strong association was found between EONS and maternal bacteremia due to any organism (aOR 2.34; 95% CI, 1.24 - 4.41; p = 0.009), GP bacteremia (aOR 3.66; 95% CI, 1.82 - 7.34; p < 0.001), or GBS (aOR 5.74; 95% CI, 2.57 - 12.81; p < 0.001). Bacteremia due to GN and Anaerobic organisms were not associated with EONS. Chorioamnionitis and antepartum fever were independent predictors for EONS associated with significant bacterial isolates.
This study underscores the significant impact of maternal GP bacteremia, particularly from GBS, on EONS. The strong association highlights the need for vigilant monitoring and interventions in pregnancies complicated by bacteremia to reduce adverse neonatal outcomes.
早发型新生儿败血症（EONS）对新生儿发病率和死亡率有显著影响，围产期产妇菌血症是潜在的危险因素。本研究旨在探讨围产期产妇菌血症与 EONS 的关系。
在卡塔尔多哈的妇女健康与研究中心进行了一项回顾性队列研究（2015-2019 年），根据分娩前 7 天至分娩后 48 小时内采集的血培养结果，比较了有菌血症和无菌血症的妇女，研究了与 EONS 的关联。
在分析的 536 份母血培养物中，102 份（19.0%）为阳性。最常见的病原体是 B 组链球菌（GBS）（39.2%），其次是大肠杆菌（14.7%）和厌氧菌（10.8%）。来自菌血症母亲的新生儿出生体重较低（2913±86g 与 3140±745g；MD 227.63g；95%CI 61.72-393.55；p=0.007），需要更多的复苏（27.5%与 13.2%；OR 2.48；95%CI 1.48-4.17；p<0.001），并且更频繁地接受抗生素治疗≥7 天（41.2%与 16.6%；OR 3.51；95%CI 2.20-5.62；p<0.001）。与非菌血症母亲的新生儿相比，来自菌血症母亲的革兰氏阳性（GP）病原体在足月妊娠中更为常见（67.9%），而革兰氏阴性（GN）和厌氧菌（9.9%）则较少。在产时，GP 菌血症占主导地位（67.1%），GN 菌血症占 21.4%，厌氧菌菌血症占 11.4%，而产后样本中 GN 菌血症更为常见。该队列中发生了 0.75%的培养证实的 EONS，影响了 3.9%的菌血症母亲的婴儿，而对照组中没有（OR 2.34；95%CI 1.27-4.31；p<0.001）。在菌血症母亲的 14.7%的婴儿中出现了培养阴性的 EONS，而对照组为 7.8%（OR 2.02；95%CI，1.05-3.88；p=0.03）。在 40 例 GBS 菌血症母亲中，3 例（7.5%）新生儿发生了培养证实的 GBS EONS，均来自 GBS 筛查阴性的母亲，而对照组中无一例发生。EONS 与任何病原体引起的菌血症（aOR 2.34；95%CI 1.24-4.41；p=0.009）、GP 菌血症（aOR 3.66；95%CI 1.82-7.34；p<0.001）或 GBS（aOR 5.74；95%CI 2.57-12.81；p<0.001）之间存在显著关联。GN 和厌氧菌引起的菌血症与 EONS 无关。绒毛膜羊膜炎和产前发热是与显著细菌分离物相关的 EONS 的独立预测因子。
本研究强调了围产期 GP 菌血症，特别是 GBS 菌血症对 EONS 的显著影响。这种强烈的关联突出表明，需要在并发菌血症的妊娠中进行警惕监测和干预，以降低不良新生儿结局的风险。
