Clinician observation of physiological trend monitoring to identify late-onset sepsis in preterm infants

AIM: To determine whether trends in routinely collected physiological variables can be used retrospectively to classify infants according to the presence or absence of late-onset neonatal sepsis. METHODS: Case control study. Thirty infants born < or =32 weeks of gestation who developed late-onset sepsis were matched with 30 controls for gestational and postnatal age but remained sepsis free. For each infant, 25 clinicians inspected 48 h of routine monitoring of heart rate, respiratory rate and oxygen saturation. Clinicians were asked to determine whether the recording was obtained from an infant who did or did not develop sepsis and also indicate how confident they were in their judgement. Clinicians were stratified into three groups by professional role. RESULTS: The median correct assignment of infant's recordings was 67% (IQR 62-72). When very confident, this improved to 82% (IQR 67-88). Overall sensitivity was 53% (IQR 43-63) and specificity 80% (IQR 67-87). Advanced neonatal nurse practitioners consistently assigned babies to the correct group more often than other professional groups. CONCLUSION: The simple observation physiological trend graphs can classify infants according to the presence or absence of late-onset neonatal sepsis. The accuracy of this method is good to strong but varies with experience of neonatal intensive care.     

早产儿晚发型败血症危险因素及病原学分析

目的探讨早产儿晚发型败血症的危险因素及病原学特点。方法选择2012年1~12月入住我院新生儿科确诊或临床诊断晚发型败血症的早产儿为观察组,同期入住未并发败血症的早产儿为对照组。回顾性分析比较两组患儿的临床资料,以及血培养检出的病原菌分布情况和药敏情况。结果观察组60例,对照组290例。单因素分析显示出生胎龄≤32周、体重〈1500 g、小于胎龄儿（SGA）、胎膜早破、胃管留置时间〉14天、经外周中心静脉置管（PICC）、胃肠外营养时间〉14天、并发坏死性小肠结肠炎（NEC）、并发巨细胞病毒（CMV）感染、新生儿重症监护室（NICU）住院时间〉5天与早产儿晚发型败血症的发生有关（P〈0.05）。Logistic回归分析显示,出生胎龄≤32周（OR=2.710,95%CI：1.200~6.121）、SGA（OR=4.114,95%CI：1.635~10.354）、PICC置管（OR=2.485,95%CI：1.178~5.239）、并发NEC（OR=15.270,95%CI：5.058~46.100）、CMV感染（OR=20.130,95%CI：5.279~76.754）为早产儿晚发型败血症的独立危险因素。观察组中20例血培养阳性,培养出革兰阴性菌13株（65%）,其中肺炎克雷伯菌10株（50%）、大肠埃希菌2株（10%）、产酸克雷伯菌1株（5%）;革兰阳性菌2株（10%）,均为表皮葡萄球菌;真菌5株（25%）,其中近平滑假丝酵母菌4株（20%）,白色念珠菌1株（5%）。13株革兰阴性菌有10株为产超广谱β内酰胺酶（ESBLS）菌株,其中8株为肺炎克雷伯菌。结论出生胎龄≤32周、SGA、PICC置管、并发NEC、CMV感染为早产儿晚发型败血症的危险因素,肺炎克雷伯菌是最主要的致病菌,耐药性强,其次是近平滑假丝酵母菌。     

产前使用抗生素与早产儿早发型及晚发型败血症关系的研究

目的探讨母亲分娩前使用抗生素与早产儿早发型败血症(EOS)及晚发型败血症(LOS)发生以及病原菌的关系。方法选取2010年1月至2012年12月间胎龄≤33周,生后24h内住院,住院时间≥24 h的单胎早产儿;将母亲分娩前使用抗生素时间≥4 h作为抗生素组,未使用或使用抗生素时间4 h为对照组,分析比较两组早产儿EOS和LOS的比例和致病菌情况。结果共入选629例早产儿,其中抗生素组232例,对照组397例。抗生素组早产儿的出生体质量、临床羊膜炎、产前激素24h、EOS的发生比例均高于对照组,窒息和呼吸窘迫综合征(RDS)的发生比例均低于对照组,差异均有统计学意义(P0.05);两组LOS发生比例差异无统计学意义(P0.05)。EOS 29例,5例(17.2%)合并化脓性脑膜炎,抗生素组EOS 16例,血培养阳性11例(68.8%),革兰阳性(G+)菌6例(37.5%),G-菌5例(31.3%);对照组EOS 13例,血培养阳性5例(38.5%),G-菌4例(30.8%),G+杆菌1例(7.7%);均以非耐药菌为主,两组EOS早产儿血培养阳性率和G+菌比例差异均无统计学意义(P0.05)。LOS 75例,5例(6.7%)合并化脓性脑膜炎,与EOS差异无统计学意义(P0.05)。抗生素组LOS 29例,血培养阳性17例(58.6%),G+菌6例(20.7%),G-菌9例(31.0%),真菌2例(6.9%);对照组LOS 46例,血培养阳性23例(50.0%),G+菌14例(30.4%),G-菌8例(17.4%),真菌1例(2.2%);均以耐药菌为主,两组LOS早产儿血培养阳性率以及G+菌比例差异均无统计学意义(P0.05)。结论母亲分娩前使用抗生素,既没有减少早产儿EOS和LOS的发生概率,也未改变病原菌的分布。     

Serum amyloid A protein is a useful inflammatory marker during late-onset sepsis in preterm infants

BACKGROUND: Few studies demonstrated that serum amyloid A (SAA), a non-specific acute-phase reactant, could be used as a reliable early marker for the diagnosis of late-onset sepsis (LOS). OBJECTIVES: To evaluate the diagnostic value and the dynamics of SAA levels during the course of LOS and to compare it to those of other inflammatory markers. METHODS: Levels of SAA, C-reactive protein (CRP) and IL-6 together with clinical variables, biochemical parameters and cultures retrieved from all preterm infants suspected of LOS were checked at the first suspicion of sepsis and after 8, 24, 48 and 72 h. Results were compared to healthy, matched infants. RESULTS: One hundred and sixteen infants were included in the study, 38 in the sepsis and 78 in the non-sepsis group. High levels of SAA were observed at sepsis onset, with a gradual decline thereafter, while CRP levels increased only at 24 h after sepsis onset. In the sepsis group, levels of SAA returned faster to baseline than CRP levels. Receiver-operating characteristic analysis values revealed that SAA at 10 mug/ml had the highest sensitivity at 0, 8 and 24 h after sepsis onset (95, 100 and 97%, respectively) and a negative predictive value (97, 100 and 98%, respectively). CONCLUSIONS: SAA is an accurate acute-phase protein during LOS in preterm infants. Quick and reliable SAA kits can make this marker a useful tool in LOS in preterm infants.     

71 例小婴儿B 族链球菌败血症早发型和晚发型临床分析

目的分析小婴儿早发型与晚发型B族链球菌(GBS)败血症的临床特征及炎性指标。方法回顾分析2011年1月至2019年12月收治的确诊为GBS败血症的小婴儿,根据发病年龄分为早发组(7日龄内)及晚发组(7～89日龄),比较两组的围生期因素、临床特点及相关炎性指标。结果收集GBS败血症小婴儿71例,早发组43例、晚发组28例。早发组中位发病时间5小时,晚发组中位发病时间17天。早发组的初产、早产、胎膜早破、胎膜早破≥18 h、气促/呻吟、肺炎发生率以及血小板减少比例均高于晚发组;发热发生率、达到最低白细胞数时间及血小板最低值低于晚发组,差异有统计学意义(P0.05)。死亡 4 例,均为早发型,其中 3 例为超低出生体质量儿。两组小婴儿对青霉素、头孢曲松、万古霉素敏感率均为100%。结论早发型 GBS 败血症常以呼吸道症状为首要表现,易合并血小板减少,超低出生体质量儿死亡率高;晚发型GBS败血症以发热为首要表现。血液及脑脊液培养菌株对青霉素、头孢曲松、万古霉素敏感率均为100%。     

Neurodevelopmental impairment in preterm infants with late-onset infection: not only in extremely preterm infants

Late-onset infection is known to increase the risk of neurodevelopmental impairment in infants born extremely preterm. However, little data is available regarding infants born moderately preterm. The aim of this study was to determine whether late-onset infection in moderately preterm infants (<35 weeks of gestation) was associated with a non-optimal neurodevelopmental outcome at 2 years of age. We analyzed a regional, population-based cohort of infants (LIFT cohort) between January 2003 and December 2009, and we used a propensity score method to reduce bias. Among the 4,618 preterm infants assessed at 2 years, 618 had acquired late-onset infection (13.4 %), and 764 had a non-optimal outcome (16.5 %). The rate of non-optimal outcomes was significantly higher in preterm infants with late-onset infection, irrespective of subgroups of gestational age and birth weight Z-score. After adjusting for the propensity score, the relationship between late-onset infection and non-optimal neurodevelopmental outcome at 2 years among infants born before 35 weeks of gestation remained significant (aOR?=?1.3; 95 % CI 1.01–1.7; p?=?.04). Conclusion: Late-onset infection is associated with poor neurological outcome at 2 years of age among infants born moderately preterm before and after adjustment for the propensity score.     

Acinetobacter junii causes life-threatening sepsis in preterm infants

Acinetobacter junii caused sepsis in six preterm infants in our neonatal unit within 48 h. Each infant with clinical signs of systemic infection and activation of the acute phase response had two positive blood cultures with Acinetobacter junii. The sudden onset, the short duration of the outbreak and the fact that none of the infants were colonized by A. junii suggested a common source of A. junii administered directly into the blood. The only feature shared by all six affected newborns was an intravenous fat emulsion (Intralipid 10%), which was shown to be an excellent growth medium for A. junii. Sepsis did not occur in four infants with 20% fat emulsion or amino acids only. Vaminolact^® did not support growth of the outbreak strain. The immediate source of the outbreak could not be identified: samples of the actual feeds given were not available for investigation, but A. junii was not isolated from parenteral solutions with identical batch numbers used in the septic infants. We conclude that Acinetobacter junii can cause a life-threatening infection in preterm neonates. Contaminated intravenous fat emulsion is implicated as a possible source of the infection. As a part of rigid infection control, intravenous feedings should be prepared under aseptic conditions.     

极低/超低出生体重儿迟发型败血症发生情况及其危险因素分析

目的探讨新生儿重症监护病房(NICU)极低/超低出生体重儿迟发型败血症(LOS)的发生情况及危险因素。方法收集2011年1月至2013年12月入住NICU的极低或超低出生体重儿的临床资料,根据是否合并LOS分为两组:LOS组和无LOS组。回顾性分析LOS的发生率、病死率、常见病原菌及危险因素。结果纳入的226例极低/超低出生体重儿中,117例(51.8%)发生了LOS,其中45例为确诊LOS,72例为临床诊断LOS。LOS组患儿病死率为13.7%(16/117),明显高于无LOS组(5/109,4.6%),差异有统计学意义(P0.05)。共培养出51株病原菌,其中32株(63%)为革兰阴性细菌,16株(31%)为革兰阳性细菌,3株(6%)为真菌。多因素logistic回归分析显示,胎龄、小于胎龄儿、肠外营养持续时间、经外周静脉穿刺中心静脉置管(PICC)、机械通气是极低/超低出生体重儿LOS发生的独立影响因素(OR分别为:0.84、1.59、1.34、3.11、4.55,均P0.05)。结论极低/超低出生体重儿LOS的发生率及病死率较高。LOS常见病原菌为革兰阴性细菌。胎龄低、肠外营养持续时间长、小于胎龄儿、PICC或机械通气的极低/超低出生体重儿LOS的发生危险可能增加。     

早产儿医院感染败血症的临床特点与病原学分析

目的调查分析早产儿医院感染败血症的临床特点、病原菌分布及药敏情况。方法回顾性分析我院新生儿科2007年1月至2011年12月发生医院感染败血症的早产儿病例。结果研究期间共出院早产儿5660例,排除染色体异常和住院时间小于5天的病例,纳入分析5392例,发生医院感染败血症81例,发生率1.5%,共治愈60例,治愈率74.1%。发病时表现多种多样,最常见的实验室指标异常是C反应蛋白（CRP）升高。病原菌以革兰阴性菌最多见（57.6%）,真菌占第二位（30.3%）。其中,革兰阴性杆菌以肺炎克雷伯菌为主,对大部分β内酰胺类抗生素耐药;革兰阳性菌以表皮葡萄球菌为主,大多对青霉素耐药,对万古霉素敏感;真菌感染均为念珠菌,对氟康唑、两性霉素B均敏感。结论早产儿医院感染败血症临床表现各异,CRP升高是较敏感的指标。致病菌主要为革兰阴性菌和真菌,革兰阴性菌对大部分β-内酰胺类抗生素耐药。     

Functional impairments at school age of preterm born children with late-onset sepsis

Background

Late-onset sepsis is a relatively common complication particularly of preterm birth that affects approximately a quarter of very low birth weight infants.

Aim

We aimed to determine the motor, cognitive, and behavioural outcome at school age of preterm children with late-onset sepsis compared to matched controls.

Study design and subjects

A prospective case-control study that included preterm infants (gestational age < 32 weeks and/or birth weight < 1500 g) admitted to our Neonatal Intensive Care Unit in 2000-2001 with a culture-proven late-onset sepsis, and controls matched for gestational age.

Outcome measures

At school age we assessed motor skills, intelligence, visual perception, visuomotor integration, verbal memory, attention, executive functioning, and behaviour.

Results

At 6-9 years, 21 of 32 children with late-onset sepsis (68%) had borderline or abnormal motor outcome with most problems in fine motor skills. Their total IQ was 89 compared to 98 in controls. In addition, verbal memory and attention were affected compared to controls (0.61 standard deviations (SD), 95% confidence interval (CI) 0.04-1.17, p = 0.033 and 0.94 SD, 95% CI 0.32-1.62, p = 0.011, respectively). Multiple episodes of sepsis and gram-negative sepsis were risk factors for worse cognitive outcome.

Conclusions

At school age, a majority of preterm children with late-onset sepsis had motor problems. Their IQ was considerably lower than matched controls, and memory and attention were specifically impaired. Outcome at school age of preterm children with late-onset sepsis was worse than previously thought.     

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。     

Clinical measures to preserve cerebral integrity in preterm infants

Impaired psychomotor development, often anteceded by major intraventricular hemorrhage or periventricular leukomalacia, constitutes the most important long-term morbidity of very preterm infants. We reviewed randomized controlled trials aimed at reducing the incidence of brain damage, as detected by ultrasound, or neurodevelopmental impairment during follow-up of preterm infants. Preliminary reports of reduced rates of intraventricular hemorrhage obtained with administration of fresh frozen plasma, ethamsylate, phenobarbitone, or morphine have not been confirmed in subsequent larger trials. Early administration of indomethacin may reduce intraventricular hemorrhage without affecting long-term outcome. Pancuronium, inositol, and vitamin E decreased intraventricular hemorrhage rates but later psychomotor development was not examined. Thyroxin supplementation failed to improve neurodevelopmental outcome while protein enrichment of formula and individualized developmental care appear to be beneficial. The largest reductions in cerebral palsy and neurodevelopmental impairment were achieved by avoidance of postnatal steroids. This finding emphasizes the need to include these late endpoints in any randomized trial involving preterm infants.     

早发及晚发型新生儿败血症的临床特征分析

目的 回顾性研究早发型败血症(early-onset sepsis,EOS)及晚发型败血症(late-onset sepsis,LOS患儿的临床表现及预后,探讨新生儿败血症的早期诊治措施。方法 回顾性分析2015年1月至2020年12月解放军总医院第五医学中心儿科收治的败血症患儿(血培养均阳性),根据发病时间分为EOS组(生后≤72 h发病,n=60)、LOS组(生后>72 h发病,n=43),对EOS组及LOS组患儿基本情况、起病症状、致病菌分布、实验室检测、预后进行分析比较。统计学方法采用t检验、秩和检验、χ²检验。结果 本研究共选入败血症患儿103例(血培养均阳性),其中EOS组60例(58.2%),LOS组43例(41.7%)。EOS组与LOS组患儿出生时羊水污染发生率[36.7%(22/60)与7.0%(3/43)]、孕母发热率[15.0%(9/60)与2.3%(1/43)]比较,EOS组均高于LOS组(χ²值分别为12.013和4.590, P值均<0.05);LOS组与EOS组患儿中早产儿[79.1%(34/43)与...     

早产儿近平滑假丝酵母菌血症与白假丝酵母菌血症的临床对比研究

目的探讨早产儿近平滑假丝酵母菌血症的临床特点。方法回顾性分析比较11例近平滑假丝酵母菌血症与13例白假丝酵母菌血症早产儿的临床资料。结果与白假丝酵母菌血症早产儿相比,近平滑假丝酵母菌早产儿的出生体质量低、住院天数长,差异均有统计学意义(t=2.16、3.79,P均<0.05);且早产儿视网膜病(ROP)发生率、亚胺培南司他丁钠使用率、气胸以及胸腔闭式引流高,两组差异均有统计学意义(χ2=4.05~5.92,P均<0.05)。Logistic回归分析显示,仅住院天数及应用亚胺培南司他丁钠进入回归方程(χ2=18.01,P=0.000)。结论住院时间及亚胺培南司他丁钠应用为早产儿近平滑假丝酵母菌血症的高危因素,其他易感因素与白假丝酵母菌血症无差别。     

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。