超低出生体重儿早发型脓毒症的临床特点
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摘要
目的了解超低出生体重儿早发型脓毒症的临床特点,以指导临床诊疗。方法对2006年1月～2017年12月笔者医院78例超低出生体重儿早发型脓毒症的临床特点进行回顾性分析。结果早发型脓毒症发生率为60. 5%,近6年显著升高(P <0. 01)。男性、26～28周胎龄、出生体重751～1000g患儿近6年比前6年早发型脓毒症的发生率上升,差异有统计学意义(P均<0. 05)。胎膜早破、产前使用抗生素、产前使用激素、性别、胎龄、出生体重、宫内生长受限与早发型脓毒症发病无显著关系。早发型脓毒症患儿第1天血白细胞计数<7. 0×10~9/L,血气分析p H值> 7. 45或<7. 25发生率显著升高(P均<0. 05)。血培养阳性率为20. 5%,以革兰阴性菌为主。结论超低出生体重儿早发型脓毒症发生率高,呈上升趋势,而血培养阳性率低。应采取各种积极措施来降低发生率,提高治愈率。
Objective To investigate the clinical characteristics of early-onset sepsis among extremely low birth weight( ELBW)infants with early-onset sepsis( EOS),so as to guide clinical diagnosis and treatment. Methods We reviewed the medical records of ELBW infants born in our hospital between 2006 and 2017,and those of infants born between 2006 and 2011 were compared with those between 2012 to 2017. Results The incidence of early-onset sepsis was 60. 5%,and the incidence was significantly higher in the last6 years( P < 0. 01). The incidence of early-onset sepsis in infants of male,gestational age at 26-28 weeks and birth weight at 751-1000 g was significantly increased in the last 6 years( P was 0. 014,0. 042,0. 000,respectively). Premature rupture of membranes,antenatal antibiotics,antenatal hormone,sex,gestational age,birth weight and intrauterine growth restriction were not risk factors for early-onset sepsis. The blood leucocyte count lower than 7. 0 × 10~9/L or pH > 7. 45 or < 7. 25 in blood gas analysis of the first day birth was much more often seen in infants with early onset sepsis( both P < 0. 05). The positive rate of blood culture was 20. 5%,which was mainly Gram-negative bacteria. Conclusion The incidence of early-onset sepsis in ELBW infants is high,and the positive rate of blood culture is low. All kinds of positive measures should be taken to reduce the incidence and improve the cure rate.
Objective To investigate the clinical characteristics of early-onset sepsis among extremely low birth weight( ELBW)infants with early-onset sepsis( EOS),so as to guide clinical diagnosis and treatment. Methods We reviewed the medical records of ELBW infants born in our hospital between 2006 and 2017,and those of infants born between 2006 and 2011 were compared with those between 2012 to 2017. Results The incidence of early-onset sepsis was 60. 5%,and the incidence was significantly higher in the last6 years( P < 0. 01). The incidence of early-onset sepsis in infants of male,gestational age at 26-28 weeks and birth weight at 751-1000 g was significantly increased in the last 6 years( P was 0. 014,0. 042,0. 000,respectively). Premature rupture of membranes,antenatal antibiotics,antenatal hormone,sex,gestational age,birth weight and intrauterine growth restriction were not risk factors for early-onset sepsis. The blood leucocyte count lower than 7. 0 × 10~9/L or pH > 7. 45 or < 7. 25 in blood gas analysis of the first day birth was much more often seen in infants with early onset sepsis( both P < 0. 05). The positive rate of blood culture was 20. 5%,which was mainly Gram-negative bacteria. Conclusion The incidence of early-onset sepsis in ELBW infants is high,and the positive rate of blood culture is low. All kinds of positive measures should be taken to reduce the incidence and improve the cure rate.
引文
1汪盈,李海静,杨祖钦,等.低体重婴儿医院感染的临床分析[J].中华医院感染学志,2013,23(2):385-387
2 张越伦,韩立中,杨智荣,等.多中心多重耐药菌医院感染肺炎危险因素研究[J].中国感染控制杂志,2014,13(9):513-517,523
3 邵肖梅,叶鸿瑁,丘小汕.实用新生儿学[M]. 4版.北京:人民卫生出版社,2011:340-342
4 Phares CR,Lynfield R,Farley MM,et al. Epidemiology of invasive group B streptococcal disease in the United States,1999-2005[J].JAMA,2008,299(17):2056-2065
5 Stoll BJ,Hansen N,Fanaroff AA,et al. Late-onset sepsis in very low birth weight neonates:the experience of the NICHD Neonatal Research Network[J]. Pediatrics,2002,110(2 Pt 1):285-291
6 中华医学会儿科学分会新生儿学组.中国住院新生儿流行病学调查[J].中国当代儿科杂志,2009,11(1):15-20
7 林丽,黄继谦,诸葛张明,等.超低出生体重儿243例存活率和并发症临床分析[J].中华新生儿科杂志,2017,32(4):259-263
8 von Linsingen R,Bicalho MDG,de Carvalho NS. Baby born too soon:an overview and the impact beyond the infection[J]. J Matern Fetal Neonatal Med,2017,30(10):1238-1242
9 Charbonneau MR,Blanton LV,Di Giulio DB,et al. A microbial perspective of human developmental biology[J]. Nature,2016,535(7610):48-55
10 Russell NJ,Seale AC,O'Sullivan C,et al. Risk of early-onset neonatal group B streptococcal disease with maternal colonization worldwide:systematic review and meta-analyses[J]. Clin Infect Dis,2017,65(Suppl_2):S152-S159
11 Mc Donald CR,Darling AM,Conroy AL,et al. Inflammatory and angiogenic factors at mid-pregnancy are associated with spontaneous preterm birth in a cohort of tanzanian women[J]. PLo S One,2015,10 (8):e0134619
12 Chaemsaithong P,Romero R,Docheva N,et al. Comparison of rapid MMP-8 and interleukin-6 point-of-care tests to identify intraamniotic inflammation/infection and impending preterm delivery in patients with preterm labor and intact membranes[J]. J Matern Fetal Neonatal Med,2018,31(2):228-244
13 Puopolo KM,Mukhopadhyay S,Hansen NI,et al. Identification of extremely premature infants at Lo-w risk for early-onset sepsis[J].Pediatrics,2017,140(5):e20170925
14 Ofman G,Vasco N,Cantey JB. Risk of early-onset sepsis following preterm,prolonged rupture of membranes with or without chorioamnionitis[J]. Am J Perinatol,2016,33(4):339-342
15 Lim WH,Lien R,Huang YC,et al. Prevalence and pathogen distribution of neonatal sepsis among very-low-birth-weight infants[J]. Pediatr Neonatol,2012,53(4):228-234
16 Carola D,Vasconcellos M,Sloane A,et al. Utility of early-onset sepsis risk calculator for neonates born to mothers with chorioamnionitis[J]. J Pediatr,2018,195:48-52(e1)
17 李燕,潘新年,韦秋芬,等.新生儿败血症病原菌分布及耐药性分析[J].中华医院感染学杂志,2015,25(3):686-687,698
18 Lee SM,Chang M,Kim KS. Blood culture proven early onset sepsis and late onset sepsis in very-low-birth-weight infants in korea[J]. J Korean Med Sci,2015,30(Suppl 1):S67-S74
19 Mularoni A,Madrid M,Azpeitia A,et al. The role of coagulasenegative staphylococci in early onset sepsis in a large European cohort of very low birth weight infants[J]. Pediatr Infect Dis J,2014,33(5):e121-125
2 张越伦,韩立中,杨智荣,等.多中心多重耐药菌医院感染肺炎危险因素研究[J].中国感染控制杂志,2014,13(9):513-517,523
3 邵肖梅,叶鸿瑁,丘小汕.实用新生儿学[M]. 4版.北京:人民卫生出版社,2011:340-342
4 Phares CR,Lynfield R,Farley MM,et al. Epidemiology of invasive group B streptococcal disease in the United States,1999-2005[J].JAMA,2008,299(17):2056-2065
5 Stoll BJ,Hansen N,Fanaroff AA,et al. Late-onset sepsis in very low birth weight neonates:the experience of the NICHD Neonatal Research Network[J]. Pediatrics,2002,110(2 Pt 1):285-291
6 中华医学会儿科学分会新生儿学组.中国住院新生儿流行病学调查[J].中国当代儿科杂志,2009,11(1):15-20
7 林丽,黄继谦,诸葛张明,等.超低出生体重儿243例存活率和并发症临床分析[J].中华新生儿科杂志,2017,32(4):259-263
8 von Linsingen R,Bicalho MDG,de Carvalho NS. Baby born too soon:an overview and the impact beyond the infection[J]. J Matern Fetal Neonatal Med,2017,30(10):1238-1242
9 Charbonneau MR,Blanton LV,Di Giulio DB,et al. A microbial perspective of human developmental biology[J]. Nature,2016,535(7610):48-55
10 Russell NJ,Seale AC,O'Sullivan C,et al. Risk of early-onset neonatal group B streptococcal disease with maternal colonization worldwide:systematic review and meta-analyses[J]. Clin Infect Dis,2017,65(Suppl_2):S152-S159
11 Mc Donald CR,Darling AM,Conroy AL,et al. Inflammatory and angiogenic factors at mid-pregnancy are associated with spontaneous preterm birth in a cohort of tanzanian women[J]. PLo S One,2015,10 (8):e0134619
12 Chaemsaithong P,Romero R,Docheva N,et al. Comparison of rapid MMP-8 and interleukin-6 point-of-care tests to identify intraamniotic inflammation/infection and impending preterm delivery in patients with preterm labor and intact membranes[J]. J Matern Fetal Neonatal Med,2018,31(2):228-244
13 Puopolo KM,Mukhopadhyay S,Hansen NI,et al. Identification of extremely premature infants at Lo-w risk for early-onset sepsis[J].Pediatrics,2017,140(5):e20170925
14 Ofman G,Vasco N,Cantey JB. Risk of early-onset sepsis following preterm,prolonged rupture of membranes with or without chorioamnionitis[J]. Am J Perinatol,2016,33(4):339-342
15 Lim WH,Lien R,Huang YC,et al. Prevalence and pathogen distribution of neonatal sepsis among very-low-birth-weight infants[J]. Pediatr Neonatol,2012,53(4):228-234
16 Carola D,Vasconcellos M,Sloane A,et al. Utility of early-onset sepsis risk calculator for neonates born to mothers with chorioamnionitis[J]. J Pediatr,2018,195:48-52(e1)
17 李燕,潘新年,韦秋芬,等.新生儿败血症病原菌分布及耐药性分析[J].中华医院感染学杂志,2015,25(3):686-687,698
18 Lee SM,Chang M,Kim KS. Blood culture proven early onset sepsis and late onset sepsis in very-low-birth-weight infants in korea[J]. J Korean Med Sci,2015,30(Suppl 1):S67-S74
19 Mularoni A,Madrid M,Azpeitia A,et al. The role of coagulasenegative staphylococci in early onset sepsis in a large European cohort of very low birth weight infants[J]. Pediatr Infect Dis J,2014,33(5):e121-125