新生儿真菌败血症四例分析

目的 探讨新生儿真菌败血症的发病特点、诊断及治疗措施.方法 回顾分析4例新生儿真菌败血症病例的高危因素、临床特点、病原种类、治疗药物及治疗效果.结果 4例新生儿真菌败血症中,4例长期使用抗生素,2例为极低体质量儿,2例中心静脉置管.放弃治疗1例,治愈3例.结论 早产、极低体质量、深静脉置管和广谱抗生素应用是新生儿真菌败血症的高危因素.新生儿真菌败血症病例临床表现不典型,实验室检查不特异,故对有以上高危因素的患儿要提高警惕,尽早诊断和治疗有助于降低病死率.     

集落刺激因子辅助治疗新生儿败血症临床应用进展

目前,新生儿败血症的发病率和病死率居高不下,成为研究的焦点。早产儿由于免疫功能不成熟,中性粒细胞数量不足和质量缺陷,败血症发病率和病死率更难控制。临床资料表明,低出生体重儿败血症发生率达164‰,长期住院者高达300‰[1]。新生儿败血症常需要联合、大剂量、长疗程抗生素治疗,但此疗法易引起菌群紊乱,破坏正常的免疫和屏障功能。集落刺激因子(colonystimulatingfactor,CSF)是一组多潜能的造血细胞生长因子,可促进     

新生儿败血症换血治疗体会

新生儿败血症属儿科急危重症 ,死亡率高。我院两年多来应用外周静脉加脐静脉同步换血术配合治疗 ,效果较好 ,现报告如下。临床资料换血治疗组１１例 ,共进行了１３例次的换血 ,其中２例换血２次 ;对照组８例。全部病例符合１９８７年上海会议新生儿败血症诊断标准 ,血培养均阳性。相关病史有 :旧法接生８例 ,胎膜早破２例 ,脐和皮肤感染４例 ,挑马牙和肠炎各１例。临床表现相似 ,均有哭声弱 ,反应差 ,面色苍白 ,其中合并中度或中度以上黄疸１５例 (７８．９ % )。两组常规治疗相同。治疗组为治疗２４～３６小时后病情未能控制 ,合并中度以上…     

新生儿败血症

新生儿败血症的发病率在我国虽已有所下降 ,但在广大农村及边远地区 ,目前仍然是引起新生儿发病和死亡的重要原因之一。其发生率占活产婴的 1‰～ 1 0‰ ,国内病死率在 1 2～ 2 0 5%这间。在国际儿童年 ( 1 979年1 0月 )于南京召开的第一次全国围产新生儿学术会议上 ,反映出新生儿败血症是常见的重要致死原因之一 ,特别是重庆医学院儿科医院吴仕孝教授在大会发言 ,做了生动报告。进入 2 0世纪 80年代以来 ,我国围产新生儿工作者对有关新生儿败血症的防治作了大量的工作。首先 ,1 987年在杭州召开的有关新生儿感染与呼衰的学术会议上制定了…     

换血疗法治疗新生儿败血症

新生儿败血症是儿科常见病与多发病，病死率较高，且常合并重度黄疸，易导致后遗症，治疗疗程长以至一些患儿不能完成疗程。我院采用换血疗法配合治疗效果好，使胆红素水平下降迅速，一般状况得以快速改善，血培养阴转率提高，缩短了疗程。现报告如下。     

新生儿厌氧菌败血症60例报告

本文报告60例新生儿厌氧菌败血症,其中丙酸杆菌16例,消化链球菌14例,消化球菌及产黑类杆菌各5例,其他如兼性氏氧葡萄球菌等。药物敏感率:氯霉素86.0%、万古霉素81.3%、丁胺卡那78.7%、林可霉素76.0%。甲硝唑58.0%、头孢拉定55.8%。作者就诊断条件与治疗进行了讨论。结果治愈41例(68.3%),死亡5例(8.3%)。     

静脉注射丙种球蛋白治疗新生儿败血症疗效观察

用静脉注射丙种球蛋白 ( IVIG) 40 0～ 6 0 0 mg/( kg·次 ) ,首次用药后三天重复一次 ,配合抗生素治疗新生儿败血症 2 0例 ,治疗后患儿 Ig G及其亚类迅速提高 ,峰值为 Ig G:1 3.1 6± 1 .72 g/L,Ig G:6 .93± 2 .79g/L,Ig G2 :3.1 6± 1 .72 g/L,Ig G3:0 .5 9± 0 .2 9g/L,Ig G4:0 .42±0 .0 4g/L。治疗后 1 0天 ,IVIG组患儿的 Ig G及亚类均高于对照组 ,即抗生素与血浆组 ,尤以早产儿显著。Ig G组病死率 1 4.3% ,对照组死率 83.3% ,经统计学处理 u=2 .493,P<0 .0 5 ,有显著差别 ,且交叉感染率、体温稳定时间 ,两组之间均有显著差异     

早产儿白假丝酵母菌败血症13例临床分析

目的：探讨早产儿白假丝酵母菌败血症的临床特点。方法：回顾性分析13例早产儿白假丝酵母菌败血症患儿的临床资料。患儿胎龄28~36周,体重1400~2815 g。结果：患儿发生白假丝酵母菌感染的时间为生后19±11 d。临床表现主要为：呼吸暂停、皮肤灌注差、反应差、反复血氧下降、皮肤灰暗、皮肤黄染、安静状态心率增快、痰多、撤机困难。在白假丝酵母菌感染时患儿血小板明显下降,C反应蛋白、血小板分布宽度升高。谷丙转氨酶、肌酸激酶同工酶、总胆红素、肌酸激酶、乳酸脱氢酶在白假丝酵母菌感染时升高,抗真菌治疗两周后肌酸激酶、乳酸脱氢酶下降明显。仅3例对氟康唑耐药,换用伏立康唑治疗有效,10例治愈,放弃治疗2例,死亡1例。结论：早产儿白假丝酵母菌败血症临床表现非特异性,生后2~3周的早产儿并发的感染,应考虑白假丝酵母菌感染的可能。白假丝酵母菌感染时,患儿血小板下降,C反应蛋白、血小板分布宽度升高、谷丙转氨酶、肌酸激酶同工酶、总胆红素、肌酸激酶、乳酸脱氢酶升高。     

早产儿败血症的病原体及其临床特征

目的 分析早产儿败血症的病原体构成及其临床特征,为早期识别和治疗早产儿败血症提供依据。方法 收集2014年1月至2018年5月血培养阳性的371例早产儿败血症患儿的临床资料,根据发病时间分为早发型组（发病日龄 < 7 d,n=73）和晚发型组（发病日龄≥ 7 d,n=298）,比较两组在病原体构成、临床特征（首发症状、起病时辅助检查、合并症、预后等）方面的差异。结果 肺炎克雷伯杆菌感染在晚发型组中占比更高（P < 0.05）,大肠埃希菌、无乳链球菌和李斯特菌感染在早发型组中占比更高（P < 0.05）。早发型组首发临床表现中呼吸困难比例高于晚发型组（P < 0.05）。早发型组血培养转阴时间、感染前抗生素使用时间及深静脉置管留置时间均短于晚发型组（P < 0.05）,晚发型组新生儿坏死性小肠结肠炎的发生率高于早发型组（P < 0.05）。早发型组放弃率高于晚发型组（P < 0.05）。结论 早产儿败血症起病时临床表现及辅助检查不典型,早发型与晚发型早产儿败血症在病原体构成及临床特征方面存在一定差异,应结合发病日龄、临床特征推断可能病原体,及早合理用药。     

Evaluation of sepsis screen for diagnosis of neonatal septicemia

Fifty clinically suspected cases of neonatal septicemia were studied for evaluating the role of sepsis screen. Sensitivity and specificity of C-reactive protein test, micro-ESR, gastric aspirate cytology for polymorphs and toxic granules in neutrophils were studied singly and in combinations of two and three tests. Positive blood culture was obtained in only 20% cases, thereby underlying the need for a sepsis screen in the diagnosis of neonatal septicemia, especially in areas where adequate micro-biological facilities are lacking.     

Pentoxifylline treatment of sepsis of premature infants: Preliminary clinical observations

Pentoxifylline (Trental, 5 mg/kg/h for 6 h) was administered to 17 premature infants with sepsis, on 3 successive days. A statistically significant decrease in mortality rate (P < 0.04) was observed in comparison to a retrospectively analysed group of 13 septic infants, who were treated in a comparative way but without the use of a pentoxifylline infusion. The suggestion that pentoxifylline may be an effective drug in the treatment of Gram-negative sepsis in premature infants should be tested in a double-blind, randomized study.     

Urinary 1H-NMR and GC-MS metabolomics predicts early and late onset neonatal sepsis

The purpose of this article is to study one of the most significant causes of neonatal morbidity and mortality: neonatal sepsis. This pathology is due to a bacterial or fungal infection acquired during the perinatal period. Neonatal sepsis has been categorized into two groups: early onset if it occurs within 3–6 days and late onset after 4–7 days. Due to the not-specific clinical signs, along with the inaccuracy of available biomarkers, the diagnosis is still a major challenge. In this regard, the use of a combined approach based on both nuclear magnetic resonance (¹H-NMR) and gas-chromatography-mass spectrometry (GC-MS) techniques, coupled with a multivariate statistical analysis, may help to uncover features of the disease that are still hidden. The objective of our study was to evaluate the capability of the metabolomics approach to identify a potential metabolic profile related to the neonatal septic condition. The study population included 25 neonates (15 males and 10 females): 9 (6 males and 3 females) patients had a diagnosis of sepsis and 16 were healthy controls (9 males and 7 females). This study showed a unique metabolic profile of the patients affected by sepsis compared to non-affected ones with a statistically significant difference between the two groups (p = 0.05).     

不同剂型布地奈德联合肺表面活性物质治疗新生儿呼吸窘迫综合征疗效的比较

目的比较不同剂型布地奈德联合肺表面活性物质(PS)对新生儿呼吸窘迫综合征(NRDS)患儿血气改善及支气管肺发育不良(BPD)发生的影响。方法将出生4 h内发生NRDS的早产儿184例随机分为4组,每组46例:PS+布地奈德气雾剂持续喷入组(简称气雾持续组)、PS+单剂布地奈德液体剂型组(简称液体组)、PS+布地奈德气雾剂单剂喷入组(简称气雾单次组)、单用PS组。比较4组治疗后动脉血气的变化及治疗后改为有创机械通气率、辅助通气时间、重复使用PS率及BPD发生率。结果治疗后第2~4天4组pH、PCO_2、氧合指数(FiO_2/PaO_2)比较差异均有统计学意义,各指标改善效果依次为气雾持续组、液体组、气雾单次组、单用PS组。气雾持续组辅助通气时间明显短于其他3组(P0.05),液体组明显短于气雾单次组及单用PS组(P0.05)。4组治疗后改用有创机械通气率、重复使用PS率及BPD发生率的比较差异均有统计学意义,其中气雾持续组这3个指标的发生率均最低,其次为液体组。结论气雾剂型布地奈德持续喷入联合PS治疗NRDS的疗效优于单剂液体剂型,但两者在降低BPD发生率方面的差异有待扩大样本量进一步研究。     

Late-onset sepsis due to Salmonella Typhi in a preterm infant in a French neonatal unit

We report a case of late-onset sepsis caused by Salmonella Typhi in a one-month old preterm infant hospitalised in our neonatal unit. An investigation of the index case was undertaken to identify the source of contamination. The patient made a complete recovery.     

Brainstem auditory response findings in late preterm infants in neonatal intensive care unit

Aim: To examine brainstem auditory function at term in late preterm infants admitted to neonatal intensive care unit (NICU). Methods: Fifty‐two preterm infants, born at 33–36 week gestation, were recruited in an NICU and were studied at term using brainstem auditory evoked response (BAER). Results: Compared with normal term infants, BAER wave V latency in the NICU preterm infants was increased at 51 and 91/sec (p < 0.05, 0.05). Intervals of III–V and I–V were increased at all 21, 51 and 91/sec clicks (p < 0.05–0.01), which was more significant at higher than lower rates. Interval ratio of III–V/I–III was increased significantly at 51 and 91/sec (p < 0.05 and 0.01). Wave I and III latencies and I–III interval did not differ significantly from normal controls at any click rates. All amplitudes of waves I, III and V amplitude tended to be reduced at higher rates, while wave I amplitude was reduced significantly at 91/sec clicks. Conclusion: There were BAER abnormalities in the NICU late preterm infants, suggesting compromised brainstem auditory function. Compared with a basically normal BAER in low‐risk late preterm infants previously reported, the abnormalities suggest that perinatal problems or complications adversely affect the late preterm auditory brainstem.     

Toll样受体2及5基因单核苷酸多态性与新生儿败血症易感性的研究

目的探讨Toll样受体(TLR)2及TLR5基因单核苷酸多态性(SNP)分布与新生儿败血症易感性的关系。方法选取2011年5月至2014年1月确诊为败血症的新生儿114例为败血症组,另选取同期172例非感染新生儿作为对照组。采用微测序技术(SNaPshot)检测TLR2(rs5743708、rs3804099)和TLR5(rs5744105)共3个位点的基因SNP,比较两组间各等位基因频率和基因型频率的分布差异;采用多因素logistic回归模型分析TLR基因型与新生儿败血症的关系。结果 TLR2基因rs3804099(C/T)和TLR5基因rs5744105(C/G)各基因型分布在两组间差异均有统计学意义(PP>0.05);TLR2基因rs5743708位点在对照组与败血症组的基因型均为GG,未发现突变。Logistic回归分析显示低胎龄(OR=3.065, PPP>0.05)、rs3804099(OR=0.876, P>0.05)和rs5744105(OR=0.820, P>0.05)基因多态性不是新生儿败血症发病的危险因素。结论 rs5743708、rs3804099和rs5744105可能均不是新生儿败血症的易感基因。     

Very low birth weight neonates who survive early-onset sepsis do not have an increased risk of developing late-onset sepsis

Background

Very low birth weight neonates (≤ 1500 g, VLBWs) have a high rate of infection and distinct baseline immune function compared with more mature populations. In critically ill children and adults, sepsis increases subsequent infection risk. It is unknown whether sepsis modifies the risk of subsequent infection in VLBWs.

Methods

We conducted a retrospective cohort study of VLBWs ≤ 32 weeks of gestation at birth cared for in 312 neonatal intensive care units in the United States from 1997 to 2011 (n = 103,376). Early-onset sepsis (EOS, culture-positive only) and late-onset sepsis (LOS, culture-positive or clinical) cases were identified. Cox proportional hazard models were used to control for clinical variables between neonates with and without EOS to determine if EOS modified risk of LOS, necrotizing enterocolitis (NEC), or death.

Results

LOS occurred in 12,112/102,317 (11.8%) neonates without EOS and in 133/1059 (12.6%) of those with EOS. After adjustment for clinical variables, the risk of LOS was not different between neonates with or without a history of EOS (hazard ratio [HR] = 0.92; 95% confidence interval [CI] 0.74, 1.16). EOS increased the risk of 120-day mortality (HR = 1.78; 95% CI 1.49, 2.13).

Conclusions

In contrast to findings in children and adults, EOS was not associated with an increased risk of LOS in this cohort. Age-specific investigations are needed to determine if post-sepsis immunologic alterations are present.