Mercer B M, Ramsey R D, Sibai B M
Department of Obstetrics and Gynecology, University of Tennessee, Memphis, USA.
Am J Obstet Gynecol. 1995 Sep;173(3 Pt 1):842-6. doi: 10.1016/0002-9378(95)90352-6.
Our purpose was to evaluate the current practice of antimicrobial prophylaxis of preterm and low-birth-weight infants and to determine the impact of intrapartum fever, group B Streptococcus carriage, intrapartum antimicrobial therapy, and duration of membrane rupture on neonatal therapy.
A total of 1356 members of the American Academy of Pediatrics were asked their practice regarding neonatal screening and antimicrobial prophylaxis. Respondents were asked to define how maternal fever, group B Streptococcus carriage, intrapartum antimicrobial therapy, and prolonged membrane rupture would affect their decisions regarding neonatal therapy.
A total of 982 responses were obtained (72.4%). Routine antimicrobial prophylaxis is given to asymptomatic preterm neonates by 33.7% of pediatricians. Prophylaxis is inconsistently given at 32 to 36 weeks but is nearly universal after intrapartum fever, regardless of intrapartum therapy. If empiric intrapartum prophylaxis was given before a preterm birth, both the incidence (47.1% vs 29.1%) and frequency of prolonged neonatal therapy (30.1% vs 17.4% > or = 7 days) would be increased. Knowledge of maternal group B Streptococcus carriage would lead to a 2.6-fold increase in treatment (75.1% vs 29.1%) and 1.8-fold increase in the incidence of prolonged therapy of preterm infants (30.9% vs 17.4%), with 45.3% giving antibiotics for > or = 1 week if intrapartum treatment had been instituted. Surprisingly, 18% of pediatricians would treat term neonates without any risk factors other than maternal group B streptococcal carriage, and 32.7% would continue treatment for > or = 7 days. The majority of pediatricians (82.6%) felt that intrapartum prophylaxis would reduce early-onset group B streptococcal sepsis, but only 46.0% felt overall neonatal sepsis would be decreased by such therapy.
Antepartum screening and intrapartum prophylaxis against group B Streptococcus by obstetricians may lead to an increased incidence and duration of treatment of preterm and term neonates by the pediatrician. The efficacy, cost, and risk of such treatment in broadly applied screening and treatment programs should be considered before a standard of care is established.
我们的目的是评估目前对早产和低体重儿进行抗菌药物预防的做法，并确定产时发热、B族链球菌携带情况、产时抗菌治疗以及胎膜破裂时间对新生儿治疗的影响。
共向1356名美国儿科学会成员询问了他们在新生儿筛查和抗菌药物预防方面的做法。受访者被要求明确产妇发热、B族链球菌携带情况、产时抗菌治疗以及胎膜长时间破裂将如何影响他们对新生儿治疗的决策。
共获得982份回复（72.4%）。33.7%的儿科医生会对无症状的早产新生儿进行常规抗菌药物预防。在孕32至36周时预防措施执行情况不一，但产时发热后几乎都会进行预防，无论产时是否进行了治疗。如果在早产前进行了经验性产时预防，延长新生儿治疗的发生率（47.1%对29.1%）和频率（30.1%对17.4%，≥7天）都会增加。了解产妇B族链球菌携带情况会使治疗增加2.6倍（75.1%对29.1%），早产婴儿延长治疗的发生率增加1.8倍（30.9%对17.4%），如果产时进行了治疗，45.3%的医生会给予抗生素≥1周。令人惊讶的是，18%的儿科医生会对除产妇B族链球菌携带外无任何危险因素的足月儿进行治疗，32.7%的医生会持续治疗≥7天。大多数儿科医生（82.6%）认为产时预防会降低早发型B族链球菌败血症，但只有46.0%的医生认为这种治疗会降低总体新生儿败血症的发生率。
产科医生进行产前筛查和产时预防B族链球菌感染可能会导致儿科医生对早产和足月儿的治疗发生率及治疗时间增加。在确立护理标准之前，应考虑这种广泛应用的筛查和治疗方案中此类治疗的疗效、成本和风险。
