肺炎支原体感染的早期病原检测

用多聚酶链反应（PCR）技术检测急性呼吸道感染咽部分泌物中的肺炎支原体（MP）90例，同时作MP及解脲脲原体（UU）培养。PCR检测MP感染阳性率13．2％，培养阳性率15％，两者结果相似。UU培养阳性率6．6％。证明MP是小儿急性呼吸道感染的重要病原体之一。PCR检测可在当天或第2天提供病原诊断依据，认为一定条件下UU亦可能引起肺炎。     

围产期生殖道支原体感染与新生儿肺炎关系的前瞻性研究

为了探讨围产期生殖道支原体感染与新生儿肺炎的关系,本研究随机入选７３９名孕妇,采用支原 培养法检测围产期阴道解脲支原体和人型支原体,根据检测结果分为支原体一组和支原体阴性组,随访观察两组新生儿肺炎发生率。研究显示支原体阳性组２４７便,支原体阴性组４９２例,两组新生儿肺炎发生率无显著性差异,进一步分组研究发现Ｍｈ（＋）Ｕｕ（－）亚组新生儿肺炎发生率显著高于支原体阴性组（１１．５％对２．２％,ＲＲ５．     

新生儿肺炎者五种支原体感染状况研究

为探讨新生儿肺炎患儿中解脲脲原体（Uu)，肺炎支原体（Mpn)，生殖支原体（Mg)，人型支原体（Mh)，发酵支原体（Mf)等五种支原体感染状况，收集了37例新生儿肺炎患者咽拭子标本，应用nested PCR(nPCR)进行了以上支原体检测。结果显示：37例新生儿肺炎患者中支原体总感染率72．9％，其中Uu检出21例（56．7％），Mpn8例（21．6％），Mg,Mh各1例（2．7％），Mf无阳性检出。因此，新生儿肺炎中至少有Uu,Mpn,Mg,Mh四种支原体感染存在，其中以Uu,Mpn感染者居多，新生儿肺炎患者有相当高的支原体感染率应值得重视。     

孕妇生殖道解脲支原体感染与新生儿感染的关系

目的：探讨解脲支原体（Ｕｕ）母婴垂直感染情况。方法选择宫颈分泌物培养阳发表际妇１０２例、阴性孕妇８０例及阳性经治疗后阴诉孕妇３６例,分３组其新生儿咽拭子Ｕｕ培养,并对新生儿Ｕｕ阳性率进行比较。结果阳性孕妇所生新生儿Ｕｕ阳性率明显高于阴性孕妇所生新生儿Ｕｕ阳性率,Ｐ〈０．００５;治疗后阳性阴转孕妇的新生儿Ｕｕ阳性率低于未经治疗的阳性孕妇其新生儿Ｕｕ阳性率,Ｐ〈０．０５;阳性孕妇阴道分娩与剖宫产所生新     

孕妇解脲支原体感染与新生儿肺炎关系探讨

目的探讨孕妇解脲支原体(UU)感染与新生肺炎的关系。方法对235例孕妇取宫颈分泌物进行解脲支原体培养(UUC)以阳性为观察组,阴性为对照组,并于分娩后取新生儿口咽分泌物进行解脲支原体培养,观察孕妇UU感染与新生儿肺炎的关系。结果观察组新生儿口咽分泌物UUC阳性率为14.3%,明显高于对照组(P＜0.01),观察组新生儿肺炎发生率48%,也明显高于对照组(P＜0.01)。结论孕妇UU感染与新生儿肺炎显著相关。     

围生期生殖道支原体感染与胎儿窘迫关系的前瞻性研究

目的 探讨围生期生殖道支原体感染与胎儿窘迫的关系。方法 随机入选７３９名孕妇，采用支原体培养法检测围产期阴道解脲支原体和人型支原体，根据检测结果分为支原体阳性组和支原体阴性组，随访观察两组胎儿窘迫发生率。结果 支原体阳性组２４７例，支原体了性组４９２例，前者胎儿窘迫发生率５．３％（１３／２４７），后者２．０％（１０／４９２），前者显著高于后者（Ｐ〈０．０５）；队列研究显示孕期支原体感染显著增加胎儿     

肺炎支原体感染与儿童哮喘关系的研究

目的探讨肺炎支原体感染与儿童哮喘发病的关系。方法支气管哮喘患儿362例，肺炎患儿288例，正常对照组30例，分别采用颗粒凝集法检测血清肺炎支原体IgM（MP—IgM）抗体；同时采用同位素放射免疫法测定哮喘患儿血清总IgE。结果（1）支气管哮喘患儿MP-IgM阳性率49．45％，显著高于肺炎患儿MP—IgM阳性率39．24％，上述两组均显著高于正常对照组6．67％；（2）在各年龄组支气管哮喘患儿MP—IgM阳性率比较中，发现学龄期儿童MP-IgM阳性率最高；（3）MP—IgM阳性的支气管哮喘患儿血清总IgE水平明显高于MP-IgM阴性哮喘患儿的血清总IgE。结论儿童肺炎支原体感染与儿童哮喘发病密切相关。     

北京地区1990—1991年支原体肺炎临床研究

１９９０～１９９１年北京地区支原体肺炎（ＭＰ）感染流行，我院应用间接血凝试验（ＩＨＡ）检测肺炎支原体血清抗体８４例，双份血清恢复期抗体上升４倍以上，或急性期抗体滴度＞１：３２者有８０例，占９５．２％，婴幼儿占１５％。婴幼儿支原体肺炎与儿童比较发热高者多，呼吸困难及肺部体征多，肺外表现少，Ｘ线改变间质型占优势，并对ＭＰ合并神经根炎和心肌心包炎等肺外表现作简要介绍。     

衣原体IgM及IgG抗体在小儿呼吸道感染病因学诊断中的意义

为阐明4岁内小儿衣原体感染的病因及发病率，检测151例下呼吸道感染小儿血清衣原体特异性抗体，结果有24．7％确诊为呼吸道衣原体感染，且22．7％为肺炎衣原体引起，沙眼衣原体仅占2％。衣原体是引起继发性免疫缺陷的危险因子，研究100例7个月－15岁反复呼吸道感染小儿的血清沙眼衣原体特异性抗体，其中55例IgM和IgG抗体阳性，8例（14．5％）有两种抗体。患儿之母亲血清抗体阳性率亦高（75％），并发现沙眼衣原体抗体平均滴度值与患儿年龄呈线性关系，在6岁以内反复呼吸道感染最多的组内特异性IgG抗体平均滴度明显高于7－15岁小儿（P＜0．05）。所以宫内感染是主要传播途径，其次是日常生活接触传染（家庭性衣原体病）。     

儿童淋病患者支原体感染情况的研究

目的为了解儿童淋病患者支原体感染的情况，进一步查清儿童淋病合并感染的情况。方法对儿科门诊89例儿童淋病患者病灶部拭子标本进行7种支原体、念珠菌、滴虫等病原体检测。结果82例女童中23例榆出支原体（28.05％），检出念珠菌和滴虫各1例（1．22％）；7例男童中3例（42．86％）检出支原体。解脲脲原体（Uu）、人型支原体（Mh）、肺炎支原体（Mpn）、穿通支原体（Mpe）、生殖支原体（Mg）、发酵支原体（Mf）、梨支原体（Mpi）7种支原体的检出率分别为20.22％，8．54％，3．38％，4．49％．3．38％，0.0。儿童淋病患者合并支原体感染率为29.20％。结论儿童泌尿生殖道感染者淋菌和支原体为主要病原菌。     

疑似非淋菌性尿道炎儿童泌尿生殖道支原体与衣原体感染状况及耐药性分析

目的 了解疑似非淋菌件尿道炎(NGU)儿童泌尿生殖道支原体、衣原体感染状况及耐药情况,为临床合理用药提供参考.方法 对146例疑为非淋菌性尿(阴)道炎患儿的泌尿生殖道标本进行支原体培养和衣原体抗原检测,同时对支原体培养阳性标本进行药敏试验.结果沙眼衣原体(Ct)阳性15例(10.3%);支原体培养阳性82例(56.2%),其中解脲支原体(Uu)阳性58例(39.7%),人型支原体(Mh)阳性9例(6.2%),uu+Mh混合感染阳性15例(10.3%);Uu+Ct混合感染阳性4例(2.7%).10种常用抗生素中,交沙霉素和白霉素耐药率较低(19.5%、22.0%),罗红霉素和阿奇霉素耐药率较高(41.5%、37.8%).结论疑似NGU儿童支原体、农原体感染率较高,支原体对常用抗生素存在不同程度的耐药性.体外药敏结果提示交沙霉素敏感性最高.     

早产儿医院感染目标性监测结果及危险因素分析

目的 分析早产儿医院感染现状、特征及相关危险因素。方法 温州市儿童医院新生儿科2011年1月至2012年12月开展医院感染目标性监测,将入住时间〉48 h的早产儿医院感染情况进行分析,并分析其高危因素。结果 研究期间共纳入早产儿563例,总住院日6310天,51例发生医院感染,共61例次,感染率9.1%,8.1例次/1000住院日。呼吸机相关性肺炎感染率17.2%,37.3例/1000呼吸机使用日;脐静脉、外周中心静脉置管血管相关性感染率12.5%,8.7例/1000导管日。早产儿医院感染病原菌主要为革兰阴性菌,占68.0%,其中肺炎克雷伯菌占24.0%,革兰阳性菌占20.0%,真菌占12.0%。多因素Logistic回归分析显示,胎龄小（OR=1.079,95%CI 1.025~1.136）、极低出生体重（OR=1.053,95%CI 1.038~1.069）、机械通气治疗（OR=4.850,95%CI 3.035~7.751）、胃肠外营养时间（OR=3.180,95%CI 2.058~4.915）、中心静脉置管（OR=4.509,95%CI 2.275~8.935）是早产儿发生医院感染的高危因素。结论 早产儿发生医院感染率较高,存在诸多医院感染易感因素,目标监测对采取防控措施有指导意义。     

Nitric oxide levels in preterm and term infants and in premature infants with bacteremia

OBJECTIVE: To determine the serum nitric oxide levels in healthy neonates and in infants with bacteremia. METHODS: We performed a prospective study in a tertiary neonatal intensive care unit. The serum nitric oxide levels were measured in all infants at birth (basal) and in the infected neonates also on the first 2 days of bacteremia. RESULTS: Thirty-three neonates (10 term, 23 preterm) were included. Eleven preterm infants (mean gestational age 27 weeks) had bacteremia. The main blood culture isolates included coagulase-negative staphylococci (n=4), Klebsiella pneumoniae (n=3), and Escherichia coli (n=3). The serum nitric oxide levels increased during infection in 10 infants (p <0.008). The mean nitric oxide level before infection was 44 microM and during infection 96 microM (p=0.008). In the healthy babies, the mean nitric oxide level was 26 microM in those with a gestational age <27 weeks, 44 microM in those born between 28 and 36 weeks of gestation, and 63 microM in term infants. CONCLUSIONS: Bacteremic preterm infants produce significantly higher amounts of nitric oxide. The basal nitric oxide levels at birth may be correlated with gestational age.     

Is routine TORCH screening and urine CMV culture warranted in small for gestational age neonates?

Background

Congenital infections are associated with a wide variety of clinical symptoms, including small for gestational age (SGA).

Aims

To determine the co-occurrence of SGA and congenital TORCH infections, as diagnosed by TORCH serologic tests and/or cytomegalovirus (CMV) urine culture.

Study design

We performed a retrospective study of all neonates admitted to our neonatal intensive care unit from January 2004 to February 2010 in whom SGA was diagnosed and TORCH serologic tests and/or CMV urine cultures were performed.

Results

TORCH serologic tests (in neonatal or maternal serum) and/or a CMV urine culture were performed in 112 neonates with SGA. None of the neonates tested positive for Toxoplasma gondii, Rubella, and Herpes simplex virus. Positive CMV urine culture was detected in 2% (2/112) of neonates, but their CMV IgM titers were negative.

Conclusions

The co-occurrence of TORCH congenital infection in infants with SGA is rare. Routine TORCH screening in neonates with isolated SGA does not seem warranted and should be limited to CMV urine cultures.     

早产胎盘病理改变与早产儿并发症的分析

目的 分析早产儿胎盘病理改变特点,探讨胎盘病理与早产及早产儿结局的关系.方法 选择2008年5月至2010年5月我院产科分娩的单胎早产儿及其胎盘为早产组,同期分娩的单胎足月儿及其胎盘为足月组,检测所有新生儿胎盘组织病理学改变,早产儿脐血C反应蛋白(CRP)、相关细胞因子白细胞介素-8(IL-8)、肿瘤坏死因子(TNF),以及神经元特异性烯醇酶(NSE),记录早产儿并发症情况.结果 与足月儿胎盘(42例)比较,早产儿胎盘(109例)形状不规则发生率高(17.4%比9.5%),但差异无统计学意义(P=0.226),胎盘子面血管分支计数少[(4.4±0.7)支比(5.4±0.7)支],差异有统计学意义(P<0.05).胎盘组织病理学显示早产儿胎盘感染性病变发生率高(77.1%比40.5%,P<0.05).早产并胎盘感染性病变时,脐血细胞因子IL-8、TNF及NSE增高,颅内出血发生率高于非感染组(P均<0.05).结论 早产胎盘形状不规则多见,血管数目少,感染性病变发生率高;早产胎盘感染性病变发生率高及脐血感染相关因子水平增高均提示感染可能是早产的原因之一,且与早产儿高患病率相关.     

Bedside prediction of neonatal pulmonary maturity by single step gastric aspirate shake test

Single step gastric aspirate shake test was carried out on 400 newborns (300 term and 100 preterm)to evaluate its reliability in the prediction of hyaline membrane disease (HMD). Eighty five percent of preterm neonates with a negative shake test developed HMD. This was statistically significant (p<0.001). Two preterm babies with a positive shake test and one with an intermediate result developed hyaline membrane disease. Amongst term neonates in 6 cases the test was false negative. The reasons for the test being negative in these sixcases have been discussed. None of the term infants with a positive or intermediate shake test developed hyaline membrane disease.     

新型冠状病毒感染期间足月的晚期新生儿咽拭子肠道病毒核酸检测横断面研究

目的 探讨新型冠状病毒感染疫情期间住院的足月的晚期新生儿咽拭子肠道病毒（enterovirus,EV核酸检测阳性率及其临床特征。方法 该研究为单中心横断面研究，研究对象为2020年10月—2021年9月在新生儿内科病房住院的611例足月的晚期新生儿。于入院时采集咽拭子进行柯萨奇病毒A16型/EV71/EV通用型核酸检测。根据EV核酸检测结果分为EV核酸阳性组（8例）和EV核酸阴性组（603例），分析比较两组患儿的临床特征差异。结果 611例患儿中，8例EV核酸检测阳性，阳性率为13.1‰，其中7例在5—10月份入院。EV核酸阳性组与EV核酸阴性组患儿起病前与有呼吸道感染症状的家庭成员接触比例分别为75.0%和10.9%(P<0.001)。两组患儿在人口学信息、临床症状、实验室检验方面差异无统计学意义（P>0.05）。结论 新型冠状病毒感染疫情期间住院的足月的晚期新生儿仍有一定比例的咽拭子EV核酸检测呈阳性但比例较低，其临床表现和实验室常规检测结果无特异性；家庭成员之间的传播可能是新生儿感染EV的重要途径。[中国当代儿科杂志，2023,25 (4):339-343]     

孕妇B族链球菌定植及其早产儿感染状况的研究

目的探讨孕妇B族溶血性链球菌（GBS）定植及其分娩早产儿的GBS感染状况,评估早产儿GBS定植的危险因素。方法采用前瞻性队列研究方法,纳入2017年1月至2018年1月分娩的859例早产孕妇作为研究对象。入院时采集孕妇阴道下段1/3和直肠拭子行GBS培养,其中515例行实时PCR GBS DNA检测。采集所纳入孕妇分娩的早产儿的口咽分泌物、胃液或血液进行GBS培养。取孕妇外周血及其分娩的早产儿脐血测定抗GBS荚膜多糖抗体水平。调查早产儿GBS感染情况和影响定植的围产因素。结果 859例孕妇阴道、直肠GBS培养阳性率为14.8%（127/859）。515例GBS DNA检测的阳性率为15.1%（78/515）。859例孕妇共分娩活产早产儿976例,其中43例（4.4%）GBS培养阳性;4例发生早发型GBS疾病,其中2例肺炎,2例早发型GBS败血症。127例GBS阳性孕妇分娩的127例早产儿中,34~<37周早产儿组GBS阳性率明显低于<34周早产儿组（P=0.013）,抗GBS荚膜多糖抗体水平明显高于<34周早产儿组（P=0.001）。多因素logistic回归分析显示胎膜早破>18 h和绒毛膜羊膜炎是早产儿GBS定植的独立危险因素（分别OR=6.556、6.160,均P < 0.05）。结论早产儿GBS阳性率及抗GBS荚膜多糖抗体水平与胎龄相关。胎膜早破>18 h和绒毛膜羊膜炎可增加早产儿GBS定植的风险。     

Infection in late preterm infants

BackgroundLate preterm (LP) are at higher risk than term infants to develop infections due to their more immature immune system. Little data about the risks and incidence of infection and sepsis in LP are present in literature.AimsTo evaluate treated infection rates and risk factors for infection in moderate and late preterm infants (gestational age = 32–36 weeks).Study designWe retrospectively studied a population of 771 moderate and late preterm infants consecutively admitted to our unit from June 2008 to November 2013.ResultsTreated infections were 128, with an incidence of 16.6%; the 90% (n = 115) occurred during the first 72 hours of life. Blood cultures were positive in 22% of cases, umbilical venous catheter cultures were positive in 26% of cases; Coagulase-negative staphylococci were the most frequently isolated pathogens. Patients of the sepsis group had a C-reactive protein (CRP) mean value of 28.27 mg/L and a procalcitonin mean value of 25.3 μg/L. Risk factors for infections were umbilical venous catheter (UVC) insertion (χ² = 15.9; p ≤ 0.05), prophylaxis with antenatal corticosteroids (χ² = 16.7; p ≤ 0.05) and birth by cesarean section, with observed values very similar to the expected values (χ² = 15.9; p = 0.1). Respiratory symptoms were found in 47 of the 60 patients in the sepsis group (78.3%).ConclusionsLate and moderate preterm infants have an increased significant risk of infection compared to term infants. Infections, given the high frequency of negative cultures in neonates, should be often suspected and treated on the basis of clinical features and inflammatory markers, trying always to avoid a possible overtreatment.