Lieu T A, Mohle-Boetani J C, Ray G T, Ackerson L M, Walton D L
Division of Research, The Permanente Medical Group, Oakland, California 94611, USA.
Obstet Gynecol. 1998 Jul;92(1):21-7. doi: 10.1016/s0029-7844(98)00147-1.
In a health maintenance organization population, we determined the incidence of early-onset (at less than or equal to 7 days) neonatal group B streptococcal (GBS) disease, the sensitivity and prevalence of labor risk factors, the adherence to a protocol for intrapartum antibiotics, and the costs for care of and outcomes of affected infants.
Mothers and infants at four health maintenance organization hospitals in northern California in 1989 to 1995 were studied retrospectively using computerized databases and chart review. In 1994, two of the four hospitals had adopted protocols similar to the ACOG recommendations for intrapartum antibiotics for women with labor risk factors (preterm, temperature 100.4F or higher, or rupture of membranes (ROM) 18 hours or more).
Among the 79,940 live births, the incidence of early-onset neonatal GBS infection was higher among preterm than among term infants (3.1 compared with 0.9 per 1000). Before protocol adoption, 68% of 65 infants with GBS had mothers with labor risk factors. Approximately 18% of all mothers had labor risk factors: 7.7% had preterm delivery, and 10.6% had term delivery with fever and/or ROM 18 hours or more. At the two hospitals that adopted GBS protocols, GBS incidence was reduced from 1.3 per 1000 in the preprotocol period to 0.8 per 1000 in the postprotocol period (P=.08). Six cases of neonatal GBS occurred after protocol adoption. Of these, four were not preventable under the protocol and two might have been preventable if protocol had been followed. Three of the 19 preterm infants with group B streptococcal disease died.
Risk factor-based protocols hold some promise to reduce GBS disease, but clinical strategies to promote protocol adherence are needed.
在一个健康维护组织人群中，我们确定了早发型（小于或等于7天）新生儿B族链球菌（GBS）疾病的发病率、分娩风险因素的敏感性和患病率、对产时抗生素治疗方案的依从性，以及受影响婴儿的护理成本和结局。
利用计算机数据库和病历回顾对1989年至1995年加利福尼亚北部四家健康维护组织医院的母亲和婴儿进行回顾性研究。1994年，四家医院中的两家采用了与美国妇产科医师学会（ACOG）对有分娩风险因素（早产、体温100.4°F或更高、胎膜破裂（ROM）18小时或更长时间）的妇女产时抗生素治疗建议相似的方案。
在79940例活产中，早产婴儿早发型新生儿GBS感染的发病率高于足月儿（每1000例中分别为3.1例和0.9例）。在采用方案之前，65例GBS感染婴儿中，68%的母亲有分娩风险因素。所有母亲中约18%有分娩风险因素：7.7%早产，10.6%足月分娩伴有发热和/或胎膜破裂18小时或更长时间。在采用GBS方案的两家医院，GBS发病率从方案实施前的每1000例1.3例降至方案实施后的每1000例0.8例（P = 0.08）。方案实施后发生了6例新生儿GBS感染。其中，4例根据方案无法预防，2例如果遵循方案可能可以预防。19例B族链球菌病早产婴儿中有3例死亡。
基于风险因素的方案有望降低GBS疾病，但需要临床策略来提高对方案的依从性。
