高度重视新生儿院内感染的防治

新生儿院内感染明显增加了围产期死亡率,导致住院费用增加和住院时间延长.文章简述了新生儿院内感染的高危因素、感染途径、主要病原体及其药物敏感情况、相应的防治措施,旨在进一步控制和降低新生儿科院内感染的发生率.     

Reduction in multiresistant nosocomial infections in neonates following substitution of ceftazidime with piperacillin/tazobactam in empiric antibiotic therapy

AIM: To evaluate the effect of a change in antibiotic protocol on pathogens that cause neonatal sepsis. METHODS: Suspected sepsis was treated with amikacin together with ceftazidime in 1995-1998 and piperacillin/tazobactam in 1999-2002. RESULTS: The annual rate for Klebsiella sepsis fell from 2.5 to 0.45 cases per 1000 admission days (p = 0.0001) between the two periods studied. CONCLUSION: The change from ceftazidime to piperacillin/tazobactam is associated with a decrease in the incidence of Klebsiella sepsis.     

新生儿侵袭性真菌感染67例临床分析

目的 探讨新生儿侵袭性真菌感染的临床特点.方法 选取2009年1月至2010年12月收治的67例侵袭性真菌感染新生儿病例,分析其病原、高危因素、临床特点、实验室检查及转归情况.结果 67例患儿均为念珠菌属感染,以白色念珠菌感染最为常见,占47.7%,其次为光滑假丝酵母菌,占43.3%;早产儿占所有病例的91.0%,其中50%以上的早产儿胎龄≤ 32周,9例存在先天性消化道畸形,11例合并有巨细胞病毒感染;25例患儿真菌感染前经外周中心静脉插管(PICC)置管时间≥ 14 d,16例气管插管机械通气治疗时间＞ 7 d;35例(52.2%)患儿白细胞计数＜ 10 × 109 /L,46例(68.7%)患儿有血小板下降,其中33例持续≥ 7 d;24例患儿伴有器官受累,包括中枢神经系统、眼及关节;47例(70.1%)经抗真菌治疗后病情好转或治愈,15例(22.4%)患儿死亡.结论 新生儿侵袭性真菌感染的病原主要为念珠菌属,尤以白色念珠菌及光滑假丝酵母菌为多见.中枢神经系统、眼及关节为常见受累器官.侵袭性真菌感染的发生、严重程度及转归与患儿的机体状态、原发病及并发症密切相关.     

Use of high‐flow nasal cannula in neonates: Nationwide survey in Japan

High‐flow nasal cannula is a new modality of respiratory support and is increasing in popularity despite the lack of supporting evidence. We investigated the prevalence of its use in tertiary neonatal units in Japan. A paper‐based survey was conducted. The response rate was 83%. High‐flow nasal cannula was used in 46/80 units (58%), of which 96% used the high‐flow nasal cannula without guidelines. It was used for several indications, including weaning off nasal continuous positive airway pressure and post‐extubation respiratory support. The main perceived benefits of the cannula included better access to the neonate and reduced risk of nasal trauma. This survey found that high‐flow nasal cannula is used without clear criteria and that clinical practice varies across neonatal units in Japan. Its use in neonates needs to be urgently evaluated.     

Plasma concentration of granulocyte-colony-stimulating factor in neonates

We determined the plasma concentration of granulocyte-colony-stimulating factor (GCSF) and the neutrophil count in 108 infants (gestational age 23–41 weeks; birthweight 478–4935 g). The GCSF levels in the very low birthweight infants without infection were comparable to those in the full-term infants. Infants as premature as 23 weeks of gestation showed similar GCSF levels to mature neonates. GCSF levels decreased significantly by day 7 after birth. The levels were not significantly correlated with the neutrophil count. The mean plasma level of GCSF increased significantly when infection developed and was significantly higher in the infants with sepsis than in those with non-septic infections ( p < 0.01). The results suggest that GCSF may be the major determinant of neutrophil kinetics both during fetal life and after birth.     

Hyperglycaemia as a possible marker of invasive fungal infection in preterm neonates

AIM: The incidence of invasive fungal infection in preterm newborns is rising steadily. Early recognition and treatment are imperative, but diagnosis is difficult as data from microbiological investigations are often poor, and clinical and laboratory signs do not help in differentiating bacterial from fungal infections. We evaluated whether glucose intolerance could represent a possible surrogate marker predictor of invasive fungal infection in preterm neonates. METHODS: We performed a case-control study on neonates with birthweight less than 1250 g admitted to our tertiary-level unit during the years 1998-2004 (n = 383), comparing those with invasive fungal infection (n = 45, group A) to matched controls with late-onset sepsis caused by bacterial agents (n = 46, group B). We investigated in both groups the occurrence of hyperglycaemia (serum glycaemia > 215 mg/dl, i.e. 12 mmol/l) in the first month of life, and its temporal relationship with the episodes of sepsis. RESULTS: Hyperglycaemia occurred significantly more often in group A (21/45, 46.6%) than in group B neonates (11/46, 23.9%) (OR 1.95, 95% CI 1.235-4.432, p = 0.008). Moreover, in 19 of 21 (90.4%) neonates with hyperglycaemia in group A, the carbohydrate intolerance episode typically occurred 72 h prior to the onset of invasive fungal infection; in contrast, no temporal relationship was found in neonates with bacterial sepsis (p = 0.002). Correction of hyperglycaemia was successfully achieved in all neonates of both groups, with no significant differences in the number of days of insulin treatment needed to normalize glycaemia (p = 0.15). CONCLUSIONS: Hyperglycaemia is significantly more frequent in neonates who subsequently develop fungal rather than bacterial late-onset sepsis, with a typical 3-d interval. We suggest that a preterm neonate whose birthweight is less than 1250 g in its first month of life should be carefully evaluated for systemic fungal infection whenever signs of carbohydrate intolerance occur.     

新生儿社区与医院内呼吸道合胞病毒肺炎的临床特点

目的了解新生儿社区与医院内呼吸道合胞病毒（RSV）肺炎的临床特点,以指导临床对新生儿RSV感染尤其是院内RSV感染肺炎进行有效防治。方法2005年11月-2006年4月新生儿科共收治RSV肺炎65例,所有患儿均有下呼吸道感染的临床表现,经X线、下呼吸道分泌物病毒检测确诊,其中社区感染56例,院内感染9例,分析两组的临床特点,并将9例院内感染患儿与国外2005年报道的9例院内暴发感染RSV的新生儿临床特点等进行比较。结果院内感染RSV患儿平均出生体重（中位数2625.0g）低于社区感染者（3342.5g）,临床表现较严重,需进行重症监护治疗者较社区感染者多（P〈0.05）。院内感染RSV患儿均存在基础疾病,同时合并细菌感染8例。9例院内感染RSV肺炎患儿与国外报道的院内感染暴发的患儿比较,平均胎龄（35＋5周、30＋3周）及出生体重（2625.0g、1757.0g）较大（P〈0.05）;需要吸氧的人数、机械通气人数两组差异均无统计学意义（P均〉0.05）,疾病严重程度相仿。结论新生儿院内RSV感染与社区感染相比病情更为严重。新生儿RSV感染常合并细菌感染。要重视RSV院内感染的防治。     

Urinary tract infections in neonates with unexplained pathological indirect hyperbilirubinemia: Prevalence and significance

Background

It is controversial to test for urinary tract infection (UTI) in patients with unexplained indirect hyperbilirubinemia in the first 2 weeks of life. We aimed to study the prevalence and significance of UTIs in such neonates who were requiring phototherapy.

Nosocomial transmission of community‐acquired methicillin‐resistant Staphylococcus aureus in a well‐infant nursery of a teaching hospital

Background: Infection due to community‐acquired strains of methicillin‐resistant Staphylococcus aureus (CA‐MRSA) has been reported with increasing frequency. Herein is described the nosocomial transmission of CA‐MRSA involving 13 neonates and two mothers in a well‐infant nursery in a teaching hospital in Saudi Arabia. Methods: From October to November 2009, temporally related cases of CA‐MRSA skin and soft‐tissue infection occurred in newborns shortly after discharge from a well‐infant nursery. An outbreak investigation including case identification, review of medical records, staff screening, environmental cultures, pulsed‐field gel electrophoresis, and a case–control study were conducted. Controls were selected from among asymptomatic neonates admitted to the same nursery and matched for the day of admission. Results: Fifteen subjects were found to be CA‐MRSA positive: 13 neonates and two mothers. The crude attack rate among neonates was 5.5% during the outbreak period. All 13 neonates presented with skin and soft‐tissue infection; one of the mothers had mastitis and a breast abscess. The source of the outbreak was not evident. Pulsed‐field gel electrophoresis showed that all of the tested isolates from one strain except one, all contained the staphylococcal cassette chromosome mec (SCCmec) type IV. Conclusion: MRSA strains that initially emerged in the community are now causing disease in health‐care settings. Adherence to standard infection control practices, including consistent hand hygiene, in newborn nurseries is important to prevent transmission in such settings.     

Estimation of rewarming time in transported extramural hypothermic neonates

Objectives: To evaluate the time taken for rewarming hypothermic neonatates and to correlate the time taken for rewarming with severity of hypothermia (WHO classification), weight, gestational age and associated morbidity.Methods: 100 extramural neonates transported to the Referral neonatal unit of a teaching hospital, with weight more than 1000 grams and abdominal skin temperature less than 36.5°C at admission were included in the study. Hypothermia was classified as per WHO recommendations. Clinical features including age, weight, gestational age, clinical diagnosis and vitals were recorded at the time of admission. Rewarming was done under a servo-controlled radiant warmer, in skin mode at set temperature of 37°C. Skin and air temperatures measured by the thermistor probe were recorded at the time of admission and then at least every 15 minutes till skin temperature reached 36.5°C. The neonates were monitored for oxygen saturation, blood glucose and capillary filling time, and stabilized promptly.Results: The mean abdominal skin temperature was 34.9±1.4°C. 72% of babies were moderately or severely hypothermic as per WHO classification. The duration of rewarming was 4.9±0.8 min, 17.5±9.5 min and 42±7.9 min for mild, moderate and severe hypothermia respectively (p=0.021). The difference in rate of rewarming between various grades of hypothermia was also significant. The duration of rewarming a baby did not differ significantly between the different weight and gestational age groups. When the rate of rewarming was expressed as rise in °C per Kg body weight per hour, it was higher in smaller and more premature babies. The rate of rewarming was slower in asphyxiated babies.Conclusions: The duration of rewarming depends on the severity of hypothermia. When rewarmed under radiant warmer using servo mode, the duration of rewarming a baby is the same irrespective of weight and gestational age. Asphyxiated babies take longer time to rewarm.     

促红细胞生成素对窒息后血清诱导HK-2细胞Omi/HtrA2胞内转位的影响

目的研究促红细胞生成素(EPO)对新生儿窒息后血清诱导人近曲肾小管上皮细胞(HK-2)Omi/HtrA2胞内转位的影响。方法以HK-2为研究对象,分为对照组、窒息组、EPO干预组、EPO+5-羟葵酸盐(5-HD)干预组,以200 ml/L窒息后24 h血清作为攻击浓度。流式细胞仪测定各组细胞凋亡率,观察各组细胞间接免疫荧光双染色Omi/HtrA2在细胞内从线粒体向胞浆的转位。结果与对照组Omi/HtrA2细胞内转位率相比,窒息组细胞凋亡率及Omi/HtrA2的细胞内转位率明显增加;与窒息组相比,EPO干预组细胞凋亡率及Omi/HtrA2的细胞内转位率明显减少;EPO+5-HD干预组细胞凋亡率及Omi/HtrA2的细胞内转位率较EPO干预组有所增加(P<0.05)。结论 EPO可减少新生儿窒息后血清诱导HK-2细胞Omi/HtrA2胞内的转位。     

Prospective study of nosocomial rotavirus infection in a paediatric hospital

Abstract Hospital-acquired enteric infections, particularly those due to rotavirus, were investigated by studying 220 patients under 3 years of age who were admitted without gastroenteritis to two paediatric general medical wards during a 10 month period. Faecal specimens were collected within 48 h of admission and then daily until the patients were discharged. Samples were also collected after discharge if patients developed enteric symptoms within 2 days of discharge. Fourteen per cent (31 of 220) of patients acquired rotavirus infections while in hospital, 23% (seven of 30) excreted rotavirus only after discharge; 29% of patients infected with rotavirus were asymptomatic (nine of 31). Acquisition of rotavirus infection was most prevalent during the months May-August, with a prevalence of 34% (12 of 35) in May. Hospitalization was prolonged in those patients who acquired rotavirus (11.1 days compared with 8.0 days, P < 0.05). This study highlights the importance of rotavirus as a cause of hospital cross-infection, particularly in the very young patient, and emphasizes the need for further assessment of factors involved in its acquisition. In order to determine correctly the incidence of hospital-acquired illness, it is essential to follow patients after discharge from hospital. This study reinforces the importance of developing preventive measures in order to reduce the frequency of this illness.