Early onset of group B streptococcal sepsis in newborn: clinical analysis of 27 cases / 中国新生儿科杂志

ABSTRACT

Objective To study the clinical features of early-onset Group B streptococcal(GBS) sepsis to improve the management of early-onset GBS sepsis.Method To review the clinical data of 27 cases of early-onset GBS sepsis in the Hospital over the past 5 years (January 2013 to November 2017),and analyze its clinical features,laboratory results,complications,prognosis and perinatal characteristics.Result A total of 27 cases of early-onset GBS sepsis were enrolled within 5 years,accounting for 0.85‰ (27/31 936) of total hospitalized patients over the same period.Among them,6 were premature infants and 21 full-term infants.The time of onset was within 24 hours.In all the cases,except for one full-term infant with fever as the initial symptom,the remainder had dyspnea as the initial symptom,accompanied by poor response and low poor muscle tone.Among them,17 patients required assisted ventilation.One of the full-term infant treated with ECMO within 48 hours after birth because of dyspnea,pulmonary hypertension and persistent hypoxemia,etc.,and improved and discharged;another 10 patients needed hood oxygen supply.5 cases (18.5％,5/27) diagnosed with purulent meningitis.In complete blood count,white blood cells ranged from (0.8～34.2)× 109/L,the minimum platelets counts was 16× 109/L,the maximum CRP was 249 mg/L,and maximum procalcitonin was＞ 100 ng/ml.All blood cultures were sensitive to penicillin.of the 27 patients,2 died despite of medical treatment,and 5 patients died as their parents worried about possible sequelae and discharged against medical advice.Therefore,tlhe total mortality rate was 25.9％ (7/27).All children were administered penicillin after the blood culture results were known,meropenem was subsequently added or replaced with vancomycin according to the clinical progress of the child.The remaining 20 patients recovered and discharged.Conclusion The clinical manifestation of early onset GBS septicemia is critically ill,with early onset,rapid progress,and high mortality.Special attention should be paid to high-risk cases during perinatal period,and early recognition with effective treatment would reduce morbidity and mortality.