Prevention of Group B Streptococcal Early-Onset Disease in Newborns
Prevention of Group B Streptococcal Early-Onset Disease in Newborns
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DOI：
10.1097/aog.0000000000003668
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发表时间：
2020-02-01
影响因子：
7.2
通讯作者：
中科院分区：
文献类型：
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B族链球菌（GBS）是新生儿感染的主要原因。新生儿GBS早发性疾病（EOD）的主要危险因素是母体泌尿生殖道和胃肠道的定植。大约50%的GBS定植妇女会将细菌传播给新生儿。垂直传播通常发生在分娩期间或胎膜破裂后。在没有分娩期抗生素预防的情况下，1-2%的新生儿将发展GBS EOD。其他危险因素包括胎龄小于37周，极低出生体重，长期胎膜破裂，羊膜内感染，年轻的母亲年龄和母亲的黑人种族。有效预防GBS EOD所需的关键产科措施仍然包括通过阴道直肠培养进行普遍产前筛查、正确的标本采集和处理、适当实施分娩期抗生素预防以及与儿科护理提供者协调。美国妇产科医师学会现在建议在妊娠36 0/7和37 6/7周之间进行通用GBS筛查。所有妊娠36 0/7-37 6/7周的阴道直肠培养GBS阳性的妇女，除非在胎膜完整的情况下进行产前剖宫产，否则应接受适当的产时抗生素预防。虽然较短的分娩期抗生素的推荐持续时间不如4小时或更长时间的预防有效，但2小时的抗生素暴露已被证明可以减少GBS阴道菌落计数，并降低临床新生儿败血症诊断的频率。必要时，不应仅仅为了在出生前提供4小时的抗生素给药而推迟产科干预。本委员会意见（包括表1、方框2和图1-3）更新并取代了CDC 2010年指南“围产期B族链球菌疾病的预防：CDC 2010年修订指南”中的产科部分。"
Group B streptococcus (GBS) is the leading cause of newborn infection. The primary risk factor for neonatal GBS early-onset disease (EOD) is maternal colonization of the genitourinary and gastrointestinal tracts. Approximately 50% of women who are colonized with GBS will transmit the bacteria to their newborns. Vertical transmission usually occurs during labor or after rupture of membranes. In the absence of intrapartum antibiotic prophylaxis, 1-2% of those newborns will develop GBS EOD. Other risk factors include gestational age of less than 37 weeks, very low birth weight, prolonged rupture of membranes, intraamniotic infection, young maternal age, and maternal black race. The key obstetric measures necessary for effective prevention of GBS EOD continue to include universal prenatal screening by vaginal-rectal culture, correct specimen collection and processing, appropriate implementation of intrapartum antibiotic prophylaxis, and coordination with pediatric care providers. The American College of Obstetricians and Gynecologists now recommends performing universal GBS screening between 36 0/7 and 37 6/7 weeks of gestation. All women whose vaginal-rectal cultures at 36 0/7-37 6/7 weeks of gestation are positive for GBS should receive appropriate intrapartum antibiotic prophylaxis unless a prelabor cesarean birth is performed in the setting of intact membranes. Although a shorter duration of recommended intrapartum antibiotics is less effective than 4 or more hours of prophylaxis, 2 hours of antibiotic exposure has been shown to reduce GBS vaginal colony counts and decrease the frequency of a clinical neonatal sepsis diagnosis. Obstetric interventions, when necessary, should not be delayed solely to provide 4 hours of antibiotic administration before birth. This Committee Opinion, including Table 1, Box 2, and Figures 1-3, updates and replaces the obstetric components of the CDC 2010 guidelines, "Prevention of Perinatal Group B Streptococcal Disease: Revised Guidelines From CDC, 2010."