目的 分析新生儿B组溶血性链球菌(GBS)败血症或合并脑膜炎的诊疗及预后情况。方法 回顾性分析2017-2020年入住解放军总医院第五医学中心的新生儿GBS败血症9例的临床资料及母孕期情况。结果 9例中只有1例其母分娩前筛查GBS阳性,并给予青霉素预防治疗;6例患儿母亲孕期筛查为阴性,2例未进行筛查(其中1例为早产儿)。早发性败血症7例,晚发性败血症2例,均伴有CRP升高,合并脑膜炎者5例,肺炎者3例,伴发热者6例,惊厥抽搐者3例;血培养检出的9株GBS对青霉素、氨苄西林、利奈唑胺、万古霉素、呋喃妥因均敏感,对克林霉素均耐药,1株对头孢曲松耐药,1株对四环素敏感,9例GBS败血症中1例单用头孢曲松治疗,余均应用青霉素联合用药;9例患儿中死亡1例,余随访6～24个月,1例发育落后,余均正常。结论 孕妇产前GBS筛查仍有漏诊可能;新生儿GBS败血症进展迅速,病残率高,需早期识别,及时发现并有针对性抗感染治疗,大多需联合用药。

Objective To analyze the diagnosis, treatment and prognosis of neonatal GBS sepsis or meningitis. Methods The clinical data and maternal status of 9 neonates with GBS septicemia admitted into the neonatal ward of our hospital from 2017 to 2020 were retrospectively analyzed. Results Among the 9 children with GBS septicemia, only 1 was GBS positive screened before delivery and given penicillin prophylactic treatment, 6 were GBS negative screened during pregnancy, and 2 were not screened for GBS (1 of them was premature). There were 7 cases of early onset sepsis, 2 cases of late onset sepsis, all accompanied by CRP elevation, 5 cases of meningitis, 3 cases of pneumonia, 6 cases of fever, 3 cases of convulsion, and 1 case of death. The rest were followed up to 6-24 months, 1 case of developmental lag, and the rest were normal. Nine strains of GBS detected by blood culture were sensitive to penicillin, ampicillin, linezolid, vancomycin and furantin, and resistant to clindamycin. One strain was resistant to ceftriaxone, and one strain was sensitive to tetracycline. Conclusions There is still a possibility of missed diagnosis in prenatal GBS screening. Neonatal GBS sepsis progresses rapidly with a high rate of death and disability, requiring early identification, timely detection and targeted anti-infection treatment, most of which require combined drugs.