Ashcraft K W, Holder T M, Amoury R A, Hall F K, Rising W D, Hall R T, Sharp R J
J Pediatr Surg. 1983 Aug;18(4):480-5. doi: 10.1016/s0022-3468(83)80205-x.
Neonatal sepsis due to group B beta-hemolytic Streptococcus (GBS) is reported to occur in about 1 out of 330 live births. Right-sided Bochdalek hernia (RBH) occurs in about 1 of 20,000 live births. The combination of group B streptococcal sepsis and delayed appearance of a right Bochdalek hernia is an infrequently reported phenomenon--18 patients have been previously reported in the English literature. We add four patients from our own experience to these previous reports. Since approximately 10% to 15% of the newborn population are exposed to group B Streptococcus we suspect that the inadequate diaphragmatic motion on the side of the Bochdalek hernia predisposes the child to development of septicemia and/or pneumonitis. Once the etiology has been established and appropriate antibiotic therapy instituted, progressive improvement in the patient's course should be seen. This is in contrast to a very significant mortality rate in many of the patients having early onset GBS. Any child, therefore, surviving early onset GBS only to deteriorate again, should be suspected of having an associated right Bochdalek hernia, and diagnostic steps should be taken to evaluate the integrity of the right diaphragm.
据报道，B族β溶血性链球菌（GBS）引起的新生儿败血症在每330例活产中约有1例发生。右侧Bochdalek疝（RBH）在每20000例活产中约有1例发生。B族链球菌败血症与右侧Bochdalek疝延迟出现的组合是一种鲜有报道的现象——英文文献中此前已报道过18例患者。我们将自己诊治的4例患者补充到这些先前的报道中。由于大约10%至15%的新生儿接触过B族链球菌，我们怀疑Bochdalek疝一侧的膈肌运动不足使患儿易患败血症和/或肺炎。一旦确定病因并开始适当的抗生素治疗，患者的病情应会逐步改善。这与许多早发型GBS患者的极高死亡率形成对比。因此，任何在早发型GBS中存活下来却又再次恶化的儿童，都应怀疑患有相关的右侧Bochdalek疝，应采取诊断措施评估右侧膈肌的完整性。
