极早早产儿早发型败血症低风险人群临床特征分析
|
摘要
目的探讨分析极早早产儿中早发型败血症低风险发病人群的临床特征,以避免抗生素的过度使用。方法收集2010年1月1日—2017年12月31日住院的极早早产儿临床资料。将无胎膜早破,同时母孕期无绒毛膜羊膜炎临床表现的极早早产儿归入低风险组,不满足低风险条件的即为对照组。根据生后72小时内血培养结果诊断早发型败血症,回顾分析两组极早早产儿的临床特点、治疗及结局。结果共纳入245例极早早产儿,其中低风险组153例(62. 4%)。与对照组相比,低风险组母亲妊娠期糖尿病和高血压比例较高,产前激素使用率较高,产前抗生素使用率较低,新生儿Apgar评分<5分比例较低,肺表面活性物质使用及呼吸支持和机械通气比例较高;低风险组的死亡风险和早发型败血症发生率都降低;差异均有统计学意义(P<0.05)。在存活时间>24小时的极早早产儿中,低风险组的呼吸窘迫综合征、动脉导管未闭、颅内出血、支气管肺发育不良的发生率均高于对照组;肺出血的发生率低于对照组,差异均有统计学意义(P<0. 05)。低风险患儿中,与抗生素短时组相比,抗生素长时组死亡、呼吸窘迫综合征、支气管肺发育不良的发生风险均增加,肺出血发生风险降低。结论早期识别极早早产儿中早发型败血症低风险人群,对减少早期经验性抗生素治疗有临床指导意义。
Objective To explore and analyze the clinical characteristics of extremely premature infants at low risk for early-onset sepsis(EOS), so as to avoid overuse of antibiotics. Method The clinical data of extremely premature infants hospitalized from January 1, 2010 to December 31, 2017 were collected. Extremely premature infants born from mothers without premature rupture of membranes and without maternal clinical manifestations of chorioamnionitis during pregnancy were classified assigned into the low-risk group, and those who did not meet the low-risk conditions were regarded assigned intoas the control group. EOS was diagnosed according to the results of blood culture within 72 hours after birth. The clinical characteristics, treatment and outcome of extremely premature infants between the two groups were retrospectively analyzed. Results A total of 245 extremely preterm infants were enrolled, including 153(62.4%) in low-risk group. Compared with the control group, mothers in low-risk group had higher rates of gestational diabetes and hypertension, higher rates of antenatal hormone use and lower rates of antenatal antibiotics use; furthermore, neonates in low-risk group had lower rates of Apgar score < 5, higher rates of pulmonary surfactant use, respiratory support and mechanical ventilation, and lower risk of death and incidence of early-onset sepsis. The differences were statistically significant(P<0.05). Among In extremely premature infants whose having survival time > 24 hours, compared with control group, infants in low-risk group had higher incidences of respiratory distress syndrome, patent ductus arteriosus, intracranial hemorrhage and bronchopulmonary dysplasia, and lower incidence of pulmonary hemorrhage than control group, and the differences were statistically significant(all P<0.05). In low-risk group, the risks of death, respiratory distress syndrome, pulmonary hemorrhage and bronchopulmonary hemorrhage in long-term antibiotic group were higher than the short-term antibiotic group. Conclusion Early identification of extremely preterm infants at low risk of early-onset sepsis in extremely preterm infants is of clinical significance in reducing early empirical use of antibiotics therapy.
Objective To explore and analyze the clinical characteristics of extremely premature infants at low risk for early-onset sepsis(EOS), so as to avoid overuse of antibiotics. Method The clinical data of extremely premature infants hospitalized from January 1, 2010 to December 31, 2017 were collected. Extremely premature infants born from mothers without premature rupture of membranes and without maternal clinical manifestations of chorioamnionitis during pregnancy were classified assigned into the low-risk group, and those who did not meet the low-risk conditions were regarded assigned intoas the control group. EOS was diagnosed according to the results of blood culture within 72 hours after birth. The clinical characteristics, treatment and outcome of extremely premature infants between the two groups were retrospectively analyzed. Results A total of 245 extremely preterm infants were enrolled, including 153(62.4%) in low-risk group. Compared with the control group, mothers in low-risk group had higher rates of gestational diabetes and hypertension, higher rates of antenatal hormone use and lower rates of antenatal antibiotics use; furthermore, neonates in low-risk group had lower rates of Apgar score < 5, higher rates of pulmonary surfactant use, respiratory support and mechanical ventilation, and lower risk of death and incidence of early-onset sepsis. The differences were statistically significant(P<0.05). Among In extremely premature infants whose having survival time > 24 hours, compared with control group, infants in low-risk group had higher incidences of respiratory distress syndrome, patent ductus arteriosus, intracranial hemorrhage and bronchopulmonary dysplasia, and lower incidence of pulmonary hemorrhage than control group, and the differences were statistically significant(all P<0.05). In low-risk group, the risks of death, respiratory distress syndrome, pulmonary hemorrhage and bronchopulmonary hemorrhage in long-term antibiotic group were higher than the short-term antibiotic group. Conclusion Early identification of extremely preterm infants at low risk of early-onset sepsis in extremely preterm infants is of clinical significance in reducing early empirical use of antibiotics therapy.
引文
[1]中华医学会儿科学分会新生儿学组,中华医学会中华儿科杂志编辑委员会.新生儿败血症诊疗方案[J].中华儿科杂志,2003,41(12):897-899.
[2]Blencowe H,Cousens S,Oestergaard MZ,et al.National,regional,and worldwide estimates of preterm birth rates in the year 2010 with time trends since 1990 for selected countries:a systematic analysis and implications[J].Lancet,2012,379(9832):2162-2172.
[3]魏克伦,杨于嘉,姚裕家,等.中国城市早产儿流行病学初步调查报告[J].中国当代儿科杂志,2005,7(1):25-28.
[4]朱燕,陈超.早产儿流行病学特征的前瞻性多中心调查[C].中华医学会第十七次全国儿科学术大会论文集.2012:287-288.
[5]Schrag SJ,Farley MM,Petit S,et al.Epidemiology of invasive early-onset neonatal sepsis,2005 to 2014[J].Pediatrics,2016,138(6):e20162013.
[6]Sato Y,Benirschke K,Marutsuka K,et al.Associations of intrauterine growth restriction with placental pathological factors,maternal factors and fetal factors;clinicopathological findings of 257 Japanese cases[J].Histol Histopathol,2013,28(1):127-132.
[7]Mc Gillick EV,Orgeig S,Williams MT,et al.Risk of respiratory distress syndrome and efficacy of glucocorticoids:are they the Same in the normally grown and growth-restricted infant[J].Reprod Sci,2016,23(11):1459-1472.
[8]Mitrovi?M,Stoji?S,Te?i?DS,et al.The impact of diabetes mellitus on the course and outcome of pregnancy during a5-year follow-up[J].Vojnosanit Pregl,2014,71(10):907-914.
[9]Mendola P,Mumford SL,M?nnist?TI,et al.Controlled direct effects of preeclampsia on neonatal health after accounting for mediation by preterm birth[J].Epidemiology,2015,26(1):17-26.
[10]Chen A,Feresu SA,Barsoom MJ.Heterogeneity of preterm birth subtypes in relation to neonatal death[J].Obstet Gynecol,2009,114(3):516-552.
[11]王昕,钱小虎,高宏伟.早产危险因素325例分析[J].同济大学学报(医学版),2002,23(4):312-314.
[12]李小毛,尹玉竹,杨越波,等.292例早产的临床因素分析[J].实用妇产科杂志,2001(02):107-108.
[13]Cordero L,Ayers LW.Duration of empiric antibiotics for suspected early-onset sepsis in extremely low birth weight infants[J].Infect Control Hosp Epidemiol,2003,24(9):662-666.
[14]Manan MM,Ibrahim NA,Aziz NA,et al.Empirical use of antibiotic therapy in the prevention of early onset sepsis in neonates:a pilot study[J].Arch Med Sci,2016,12(3):603-613.
[15]Cotten CM,Taylor S,Stoll B,et al.Prolonged duration of initial empirical antibiotic treatment is associated with increased rates of necrotizing enterocolitis and death for extremely low birth weight infants[J].Pediatrics,2009,123(1):58-66.
[16]Ting JY,Synnes A,Roberts A,et al.Association between antibiotic use and neonatal mortality and morbidities in very low-birth-weight infants without culture-proven sepsis or necrotizing enterocolitis[J].JAMA Pediatr,2016,170(12):1181-1187.
[17]Schulman J,Dimand RJ,Lee HC,et al.Neonatal intensive care unit antibiotic use[J].Pediatrics,2015,135(5):826-833.
[18]Arboleya S,Sánchez B,Milani C,et al.Intestinal microbiota development in preterm neonates and effect of perinatal antibiotics[J].J Pediatr,2015,166(3):538-544.
[19]Arboleya S,Sánchez B,Solís G,et al.Impact of prematurity and Perinatal Antibiotics on the Developing Intestinal microbiota:A Functional Inference Study[J].Int J Mol Sci.2016,17(5).pii:E649.
[20]Vangay P,Ward T,Gerber JS,et al.Antibiotics,pediatric dysbiosis,and disease[J].Cell Host Microbe,2015,17(5):553-564.
[21]Unger S,Stintzi A,Shah P,et al.Gut microbiota of the verylow-birthweight infant[J].Pediatr Res,2015,77(1-2):205-213.
[22]朱丹萍,杜立中,余加林,等.早产儿早期经验性应用抗生素对其肠道菌群的近期影响[J].中国循证儿科杂志,2016,11(01):26-29.
[23]Mshvildadze M,Neu J,Shuster J,et al.lntestinal microbial ecology in premature infants assessed with non-culture-based techniques[J].J Pediatr,2010,156(1):20-25.
[2]Blencowe H,Cousens S,Oestergaard MZ,et al.National,regional,and worldwide estimates of preterm birth rates in the year 2010 with time trends since 1990 for selected countries:a systematic analysis and implications[J].Lancet,2012,379(9832):2162-2172.
[3]魏克伦,杨于嘉,姚裕家,等.中国城市早产儿流行病学初步调查报告[J].中国当代儿科杂志,2005,7(1):25-28.
[4]朱燕,陈超.早产儿流行病学特征的前瞻性多中心调查[C].中华医学会第十七次全国儿科学术大会论文集.2012:287-288.
[5]Schrag SJ,Farley MM,Petit S,et al.Epidemiology of invasive early-onset neonatal sepsis,2005 to 2014[J].Pediatrics,2016,138(6):e20162013.
[6]Sato Y,Benirschke K,Marutsuka K,et al.Associations of intrauterine growth restriction with placental pathological factors,maternal factors and fetal factors;clinicopathological findings of 257 Japanese cases[J].Histol Histopathol,2013,28(1):127-132.
[7]Mc Gillick EV,Orgeig S,Williams MT,et al.Risk of respiratory distress syndrome and efficacy of glucocorticoids:are they the Same in the normally grown and growth-restricted infant[J].Reprod Sci,2016,23(11):1459-1472.
[8]Mitrovi?M,Stoji?S,Te?i?DS,et al.The impact of diabetes mellitus on the course and outcome of pregnancy during a5-year follow-up[J].Vojnosanit Pregl,2014,71(10):907-914.
[9]Mendola P,Mumford SL,M?nnist?TI,et al.Controlled direct effects of preeclampsia on neonatal health after accounting for mediation by preterm birth[J].Epidemiology,2015,26(1):17-26.
[10]Chen A,Feresu SA,Barsoom MJ.Heterogeneity of preterm birth subtypes in relation to neonatal death[J].Obstet Gynecol,2009,114(3):516-552.
[11]王昕,钱小虎,高宏伟.早产危险因素325例分析[J].同济大学学报(医学版),2002,23(4):312-314.
[12]李小毛,尹玉竹,杨越波,等.292例早产的临床因素分析[J].实用妇产科杂志,2001(02):107-108.
[13]Cordero L,Ayers LW.Duration of empiric antibiotics for suspected early-onset sepsis in extremely low birth weight infants[J].Infect Control Hosp Epidemiol,2003,24(9):662-666.
[14]Manan MM,Ibrahim NA,Aziz NA,et al.Empirical use of antibiotic therapy in the prevention of early onset sepsis in neonates:a pilot study[J].Arch Med Sci,2016,12(3):603-613.
[15]Cotten CM,Taylor S,Stoll B,et al.Prolonged duration of initial empirical antibiotic treatment is associated with increased rates of necrotizing enterocolitis and death for extremely low birth weight infants[J].Pediatrics,2009,123(1):58-66.
[16]Ting JY,Synnes A,Roberts A,et al.Association between antibiotic use and neonatal mortality and morbidities in very low-birth-weight infants without culture-proven sepsis or necrotizing enterocolitis[J].JAMA Pediatr,2016,170(12):1181-1187.
[17]Schulman J,Dimand RJ,Lee HC,et al.Neonatal intensive care unit antibiotic use[J].Pediatrics,2015,135(5):826-833.
[18]Arboleya S,Sánchez B,Milani C,et al.Intestinal microbiota development in preterm neonates and effect of perinatal antibiotics[J].J Pediatr,2015,166(3):538-544.
[19]Arboleya S,Sánchez B,Solís G,et al.Impact of prematurity and Perinatal Antibiotics on the Developing Intestinal microbiota:A Functional Inference Study[J].Int J Mol Sci.2016,17(5).pii:E649.
[20]Vangay P,Ward T,Gerber JS,et al.Antibiotics,pediatric dysbiosis,and disease[J].Cell Host Microbe,2015,17(5):553-564.
[21]Unger S,Stintzi A,Shah P,et al.Gut microbiota of the verylow-birthweight infant[J].Pediatr Res,2015,77(1-2):205-213.
[22]朱丹萍,杜立中,余加林,等.早产儿早期经验性应用抗生素对其肠道菌群的近期影响[J].中国循证儿科杂志,2016,11(01):26-29.
[23]Mshvildadze M,Neu J,Shuster J,et al.lntestinal microbial ecology in premature infants assessed with non-culture-based techniques[J].J Pediatr,2010,156(1):20-25.