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目的探讨早发型新生儿B族链球菌(GBS)败血症的围生期临床特征,提高对本病的认识和治疗水平。方法收集2005—2009年我院分娩的新生儿资料,回顾性分析GBS败血症患儿的围生期因素、发病时间、临床表现、实验室检查、治疗和预后。结果 GBS败血症7例,均为早发型感染,检出率为0.113‰。早产儿1例,生后即反应低下、呻吟、呼吸困难;实验室检查:WBC2.6×109/L,N0.76,CRP55mg/L,需呼吸机治疗。足月儿6例,于生后48h内发病,临床表现有呼吸困难、精神反应差、青紫、发热、肌张力异常等,其中1例合并化脓性脑膜炎者出现惊厥;实验室检查:WBC1.9～24.9×109/L,N0.38～0.88,CRP17～>160mg/L,1例需经鼻持续气道正压通气辅助呼吸。7例均合并肺炎,青霉素联合头孢吡肟或美罗培南治疗有效。结论我国存在新生儿GBS败血症散发病例,病情严重。应重视围生期高危因素和早期临床表现。尽早行病原学检测,选择敏感抗生素治疗可有效降低病死率。
Objective To investigate the perinatal clinical features of early-onset neonatal B-streptococcal (GBS) sepsis and to improve the understanding and treatment of this disease. Methods The data of newborns delivered in our hospital from 2005 to 2009 were collected. The perinatal factors, onset time, clinical manifestations, laboratory tests, treatment and prognosis of children with GBS sepsis were analyzed retrospectively. Results 7 cases of GBS sepsis were all early-onset infection with the detection rate of 0.113 ‰. 1 case of premature infants, low reaction after birth, moaning, dyspnea; laboratory tests: WBC2.6 × 109 / L, N0.76, CRP55mg / L, required ventilator therapy. Full-term children in 6 cases, within 48h after onset, clinical manifestations of dyspnea, poor mental response, bruising, fever, abnormal muscle tone, including 1 cases of purulent meningitis convulsions; laboratory examination: WBC1. 9 ~ 24.9 × 109 / L, N0.38 ~ 0.88, CRP17 ~> 160mg / L. One case needed nasal continuous positive airway pressure assisted breathing. Seven cases were complicated by pneumonia, penicillin combined with cefepime or meropenem treatment. Conclusion There are cases of neonatal GBS sepsis in our country, and the condition is serious. Should pay attention to the high risk factors and early clinical manifestations of perinatal period. As early as possible pathogenic detection, the choice of sensitive antibiotic treatment can effectively reduce the case fatality rate.