新生儿B族链球菌败血症33例临床分析

目的：探讨新生儿B族链球菌(group B streptococcus,GBS)败血症的临床特点。方法收集2011年3月至2014年10月泉州市儿童医院NICU收治的GBS败血症患儿的资料,回顾性分析GB S败血症患儿的围产因素、临床表现、实验室检查、治疗与转归。结果 GB S 败血症33例,占住院患儿的2.0‰(33/16448)。其中早发型败血症21例,均为足月儿,呼吸窘迫13例、气促11例、青紫10例。晚发型败血症12例,足月儿8例,早产儿4例,以高热为首发症状入院10例,6例合并化脓性脑膜炎。33例血GB S阳性标本均对万古霉素敏感,青霉素联合美罗培南治疗有效,其中18例治愈出院,临床好转后自动出院9例,死亡2例,放弃治疗死亡4例,总病死率18.2%。结论新生儿GB S败血症临床症状明显,早发型病例以呼吸系统症状为主,晚发型病例以高热为首发症状。母孕后期应常规筛查,重视新生儿早期临床表现,尽早行病原学检测,合理足疗程使用敏感抗生素治疗。

Clinical analysis of 33 cases of neonatal group B streptococcal sepsis

Objective To explore the clinical characteristics of neonatal group B streptococcal sepsis (GBS)sepsis in order to provide the guide for early diagnosis and appropriate treatment.Methods A retro-spective review was performed and a total of 33cases of neonatal GBS sepsis were identified in the NICU of Children′s Hospital of Quanzhou from March 2011to October 2014.The perinatal factors,clinical characteris-tics,laboratory finding,treatment and prognosis were analyzed.Results A total of 33cases of neonatal GBS sepsis were identified.The incidence of neonatal GBS sepsis was 2.0‰(33/16448)among all the NICU pa-tients admitted at the same period.All 21cases of early-onset GBS sepsis were term infants,which had 13ca-ses of respiratory distress,11cases of anhelation and 10cases of cyanosis as main initial clinical symptoms. Among 12late-onset cases,8occurred in term infants,10with ardent fever as the main initial clinical symp-toms,6combined with purulent meningitis.All the GBS strains were sensitive to vancomycin,then penicillin combined with meropenem therapy was effective.Of the 33patients,18cured,9discharged with improve-ment,2died,4patients died during hospitalization after being given up because of serious complication,total mortality was 18.2%.Conclusion The clinical manifestations of neonatal GBS sepsis are usually obviously and fatally,and with a high mortality.Antepartum prophylaxis,early diagnosis and timely sensitive antibiotics therapy are vital for reducing the incidence of complications and mortality of neonatal GBS sepsis.