16例新生儿B族链球菌败血症临床分析  

Clinical analysis of 16 cases of neonatal group B streptococcal septicemia

作　　者：王晓娜[1] 丛桂敏 佟成龙 武家淳 WANG Xiaona;CONG Guimin;TONG Chenglong;WU Jiachun(Department of Clinical Laboratory,ShenyangWomen and Children Hospital,Shenyang,Liaoning,110011,China)

机构地区：[1]沈阳市妇婴医院检验科,辽宁沈阳110011

出　　处：《当代医学》2021年第15期65-67,共3页Contemporary Medicine

基　　金：辽宁省自然科学基金(20170540816)。

摘　　要：目的探讨新生儿B族链球菌(group B streptococcus,GBS)败血症的临床特点、治疗及预后。方法回顾性分析本院2014年1月至2019年7月NICU收治的16例GBS败血症患儿的临床资料,分析围产期特点、临床表现、实验室检查、并发症及预后等。结果新生儿科共收治新生儿7506例,确诊新生儿GBS败血症患儿16例,新生儿GBS败血症发生率为2.13‰(16/7506)。其中早发型GBS感染14例,发生率为1.87‰(14/7506),晚发型GBS感染2例,发生率为0.27‰(2/7506)。感染患儿中,7例孕母发生胎膜早破,2例孕母发生羊水Ⅲ度污染,4例孕母存在妊娠期糖尿病,1例孕母分娩前发热1例;2例迟发型GBS败血症患儿均为足月新生儿,14例早发型GBS败血症患儿发病时间均为出生后24 h内。临床症状主要为呼吸系统症状,其中6例患儿存在气促、呻吟,机体表现为反应差。2例迟发型GBS败血症患儿的发病时间为出生后第3周,临床症状主要为高热,并伴气促、拒奶、黄疸等症状。平均白细胞(14.57±6.18)×10^(9)/L,其中>20×10^(9)/L为3例,2例降低,平均C反应蛋白(33.24±13.17)mg/L,最高116.5 mg/L,4例正常。15例患儿有不同程度的代谢性酸中毒,1例患儿失代偿性代酸并呼吸性碱中毒。16例均在入院24 h内完善胸部X线检查,9例为重症肺炎表现;所有患儿在血培养结果出来后均使用大剂量青霉素,并根据患儿病情更换为头孢哌酮/舒巴坦治疗,其中5例给予丙种球蛋白支持治疗,3例患儿需呼吸机辅助呼吸,2例因病情危重转入上级医院继续治疗。其余6例患儿均临床治愈出院,8例好转出院。结论新生儿GBS感染的风险高,临床症状不典型,预后差,建议临床医生对35~37周孕产妇开展GBS筛查,制定针对性的预防策略,以降低新生儿GBS的感染率,改善预后。Objective To explore the clinical characteristics,treatment and prognosis of neonatal group B streptococcus(GBS)sepsis,and to provide scientific reference for clinical improvement of neonatal GBS sepsis.Methods The clinical data of 16 children with GBS sepsis admitted to NICU from January 2014 to July 2019 were retrospectively analyzed.The perinatal characteristics,clinical manifestations,laboratory examinations,complications and prognosis were analyzed.Results Atotal of 7506 neonates were treated in Department of Neonatal.16 neonates with GBS sepsis were diagnosed.The incidence of GBS sepsis in neonates was 2.13‰(16/7506).The incidence of early-onset GBS infection was 1.87‰(14/7506),and that of late-onset GBS infection was 0.27‰(2/7506).Among the 16 mothers,7 had premature rupture of membranes,2 had third degree amniotic fluid contamination,4 had gestational diabetes mellitus,1 had prenatal fever,and 2 had delayed GBS sepsis.The onset time of 14 cases of early-onset GBS sepsis was within 24 hours after birth.The main clinical symptoms were respiratory symptoms,of which 6 children had shortness of breath and groaning,and the body showed poor response.2 cases of delayed GBS septicemia occurred in the third week after birth.The main clinical symptoms were high fever,accompanied by shortness of breath,milk rejection,jaundice and other symptoms.Mean leukocyte count was(14.57±6.18)×10^(9)/L,of which>20×10^(9)/L in 3 cases,2 cases decreased,mean C-reactive protein(33.24±13.17)mg/L,the highest was 116.5 mg/L,4 cases were normal.There were 15 cases of metabolic acidosis and 1 case of decompensated acid and respiratory alkalosis.The chest X-ray examination was completed in 16 cases within 24 hours of admission,and 9 cases showed severe pneumonia.All the children were treated with high-dose penicillin after the results of blood culture,and were replaced with cefoperazone/sulbactam according to the condition of the children among them.5 cases were treated with gamma globulin support,3 cases needed ventilator-assis

关 键 词：新生儿 B族链球菌 败血症 

分 类 号：R722.1[医药卫生—儿科]