新生儿解脲脲原体定植及肺部感染的探讨

近年来发现解脲脲原体(Ureaplasma urealyticmm,简称UU)对胎儿有致病性。孕妇感染UU不仅可影响妊娠结局,包括早产、低出生体重及宫内发育迟缓等,而且与新生儿疾病特别是新生儿肺炎有相关性。孕妇生殖道如果有UU感染,UU有可能垂直传播给胎儿及新生儿。而新生儿及患病新生儿UU定植及致病情况如何,我国尚少报道。我们于     

围生期解脲脲原体感染

解脲脲原体（ureaplasmaurealyticum，UU）是12种致病的支原体感染中寄居人类泌尿生殖过中常见病原体，也是引起围生期母婴感染的重要病原体之一。80年代后国外研究报道较多，国内近年来开始研究，逐步认识本病在国内也并不少见。病原与流行病学UU届人支原体科脲原体属。有12个     

新生儿解脲脲原体和人型支原体感染药敏分析

我科于2001年4～10月对90例住院新生儿的咽拭子进行分离培养和PCR检测 ,结果解脲脲原体 (Uu)阳性24例 ,占26.7% ;人型支原体(Mh)阳性17例 ,占18.9%。为了解新生儿期Uu和Mh的耐药性 ,用法国BioMerieux公司生产的支原体IST试剂盒对16株Uu和Mh进行药敏试验 ,结果表明 ,Uu耐药最高为红霉素 (耐药率81.3% ) ,其余依次为强力霉素、氧氟沙星、交沙霉素 (耐药率分别为37.5%、37.5 %、6.3% ) ;Mh耐药最高为红霉素 (耐药率为37.5 % ) ,其余依次为氧氟沙星、强力霉素 (耐药率分别为18.8 %、12.5 % ) ,Mh对交沙霉素几乎都敏感 ,未发现耐药菌珠。…     

围生期解脲脲原体感染

解脲脲原体（ｕｒｅａｐｌａｓｍａｕｒｅａｌｙｔｉｃｕｍ，ＵＵ）是定植于人类泌尿生殖系统的一种常见微生物，也是引起围生期感染的常见病原体。孕妇感染ＵＵ可导致不良妊娠结局，如死胎、死产、流产、早产和低出生体重儿，ＵＵ通过垂直传播可以引起新生儿呼吸系统感染，中枢神经系统感染以及败血症等。ＵＵ感染的临床表现轻重不一，症状多不典型，确诊需要依靠实验室检查，包括ＵＵ培养、血清特异性抗体检测以及聚合酶链反应（ＰＣＲ）等。治疗首选大环内酯类抗生素。对于有生殖道ＵＵ感染的孕妇，预防性给药或许能降低围生期新生感染的发病率。     

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。     

围产期母婴解脲支原体感染的初步探讨

解脲支原体（ＵｒｅａｐｌｌａｓｍａＵｒｅａｌｙｔｉｃｕｍ简称Ｕｕ）是婴幼儿患呼吸道感染的一个重要病区,近年来似有流行趋势,是否可在孕妇及其所分娩的新生儿中引起传播,本文作了初步探讨。资料来源和方法一、标本来源和处理所有标本均为我院产科住院的产妇及其所分娩的新生儿,收集产妇分娩前的静脉血、新生儿的脐带血、胎盘组织及新生儿咽拭子各一份。取标本时均为无菌操作,并注意避免感染胎盘组织及咽拭子放入无菌的培养基中。以上标本均放在冰箱内冷藏待检测。二、实验方法采用首都儿科研究所细菌室提供的试剂盒１．血清：用Ｅ…     

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     

34周以下早产儿解脲脲原体感染临床特征分析

目的探讨34周早产儿解脲脲原体(UU)感染的临床特征。方法选取232例34周早产儿,用实时荧光定量聚合酶链反应法检测入院24h内下呼吸道分泌物中UU,并分为阳性和阴性组,比较其临床特征的差异。结果232例早产儿中,UU阳性97例;阳性组平均胎龄和出生体质量均低于阴性组,差异有统计学意义(P均0.01)。两组间性别、母亲妊娠期高血压、产前使用激素、围生期窒息的差异无统计学意义(P0.05),阳性组母亲绒毛膜羊膜炎、胎膜早破、经阴道分娩率均高于阴性组,差异有统计学意义(P0.01)。生后24h、72h,阳性组的白细胞及中性粒细胞计数均较阴性组增高,差异有统计学意义(P0.05)。阳性组出生1周后肺部损伤较阴性组明显,差异有统计学意义(P0.05)。阳性组呼吸机撤机后需重新机械通气,以及第10天仍需机械通气的比例高于阴性组,差异有统计学意义(P均0.05)。出生28d时,阳性组支气管肺发育不良发生率高于阴性组,急性呼吸窘迫综合征发生率低于阴性组,差异均有统计学意义(P均0.05);两组间早产儿视网膜病、脑室内-脑室周围出血、脑室周白质软化、新生儿坏死性小肠结肠炎及出院时宫外发育迟缓发生率的差异无统计学意义(P0.05)。结论34周以下早产儿下呼吸道分泌物UU检测阳性可能与早产、低出生体质量有关,并可引起慢性肺部损伤。     

解脲脲原体感染与新生儿疾病

解脲脲原体(UU)属于机会致病微生物,广泛定植于育龄期女性生殖道,可通过垂直传播造成胎儿感染。新生儿UU感染后可引起多系统损害,如肺炎、支气管肺发育不良、坏死性小肠结肠炎、颅内出血、脑膜炎及早产儿视网膜病等。因此,了解UU的生物学特性、流行病学特点及与UU感染相关的新生儿疾病,重视UU的早期筛查和早期干预,把握最佳治疗...     

极低出生体重儿呼吸道分泌物解脲脲原体阳性与肺部损伤的关系

目的 探讨极低出生体重儿呼吸道分泌物解脲脲原体（UU）阳性与肺部损伤的关系。方法 选择2011年10月至2013年5月我院新生儿重症监护病房收治的极低出生体重儿,采用荧光定量聚合酶链反应法检测入院时呼吸道分泌物UU核酸,根据检测结果分为阳性组和阴性组。比较两组入院时感染标记物、新生儿呼吸窘迫综合征、先天性肺炎发生率的差异,以及住院时间28天以上者支气管肺发育不良发生率。结果 174例极低出生体重儿中,UU阳性69例,阴性105例;UU阳性组新生儿呼吸窘迫综合征发生率（26.1%,18/69）低于阴性组（56.2%,59/105）;先天性肺炎发生率（47.8%,33/69）高于阴性组（31.4%,33/105）;住院28天以上的VLBWI 145例,其中UU阳性56例,阴性89例,两组支气管肺发育不良发生率差异无统计学意义。而对于体重〈1250 g的极低出生体重儿,UU阳性组支气管肺发育不良发生率（74.1%,20/27）高于阴性组（45.0%,18/40）。结论 呼吸道分泌物UU阳性增加了极低出生体重儿先天性肺炎、出生体重〈1250 g的极低出生体重儿支气管肺发育不良的发生风险,是新生儿呼吸窘迫综合征的保护性因素。     

Certain type of chronic lung disease of newborns is associated with Ureaplasma urealyticum infection in utero

BACKGROUND: Recent studies of chronic lung disease (CLD) of newborns emphasize the contribution of antenatal infection. However, the association of Ureaplasma urealyticum infection and CLD has been controversial. The purpose of the present paper was to determine whether U. urealyticum is associated with chorioamnionitis (CAM) and a certain type of CLD. METHODS: One hundred and five infants <32 weeks of gestation who were admitted to the neonatal intensive care unit at Jichi Medical School Hospital, who underwent both histological and microbiological examinations and who survived to discharge were included. CAM was determined by histological examination. Placenta, gastric and tracheal aspirates, and nasopharyngeal swabs were cultured for Mycoplasma and other microorganisms. CLD was defined as oxygen needed at 28 days of age with symptoms of persistent respiratory distress and hazy or emphysematous and fibrous appearance upon X-ray. CLD was further divided into two subtypes according to the presence of antenatal infection. RESULTS: CAM was associated with premature rupture of membrane (odds ratio [OR], 10.19; 95% confidence interval [CI]: 3.10-33.56), placental colonization of U. urealyticum (OR 6.73, 95%CI: 1.89-23.91), neonatal colonization of other microorganisms (OR 7.33, 95%CI: 1.22-44.13) and level of IgM (OR 1.06, 95%CI: 1.01-1.11). Comparisons between CLD and non-CLD patients showed that gestational age (OR 0.43, 95%CI: 0.30-0.61) and white blood cell count (WBC) at birth (OR 1.06, 95%CI: 1.01-1.11) were risk factors for CLD, while gestational age (OR 0.38, 95%CI: 0.23-0.64), neonatal colonization of U. urealyticum (OR 5.98, 95%CI: 1.17-30.6) and WBC (OR 1.08, 95%CI: 1.01-1.15) were independent risk factors for infection-related CLD compared with non-CLD. Within CLD, infection-related CLD was associated with neonatal colonization of U. urealyticum (OR 43.7, 95%CI: 2.84-673.8) and WBC (OR 1.27, 95%CI: 1.07-1.50). CONCLUSIONS: Placental colonization of U. urealyticum was significantly related to CAM; and neonatal colonization of U. urealyticum and leukocytosis at birth were risk factors for infection-related CLD.     

Ureaplasma urealyticum and chronic lung disease

Neonatal lower respiratory tract colonisation with mycoplasma organisms was examined for an association with chronic lung disease.Ureaplasma urealyticum colonised 9/70 (13%) infants less than 1500 g. Seven (78%) colonised and 33 (54%) non-colonised infants developed chronic lung disease. Logistic regression analyses revealed early gestation, but not mycoplasma colonisation, was independently associated with chronic lung disease.     

Ureaplasma urealyticum and its association with chronic lung disease in Asian neonates

OBJECTIVE: The aim of the present prospective cohort study was to evaluate the relationship between lower respiratory tract colonization with Ureaplasma urealyticum and development of chronic lung disease (CLD) in a high-risk neonatal population. METHODS: Prospective cohort study of preterm infants with a birthweight < 1,500 g needing mechanical ventilation within 24 h of birth in a tertiary care neonatal unit. Endotracheal aspirates from these infants were cultured within 24 h for U. urealyticum and the rate of colonization was determined. The primary outcome measure was the incidence of CLD at 28 days of life. RESULTS: Of the 41 infants studied, 10 (24%) infants were colonized with U. urealyticum. The colonization rate was higher in babies < 1,000 g compared with babies weighing 1,000-1,500 g (P = 0.04). There was no significant difference between the colonized and non-colonized groups with regard to the antenatal use of steroids, maternal prolonged rupture of membranes, gestational age, birthweight, sex, respiratory distress syndrome, use of surfactant, patent ductus arteriosus and gastrooesophageal reflux. Of the 37 survivors, 20 (54%) developed CLD; eight infants (88.5%) in the colonized group developed CLD compared with 12 infants (42.8%) in the non-colonized group (P = 0.01). CONCLUSIONS: Neonates colonized with U. urealyticum were twice as likely to have CLD than non-colonized babies (relative risk 2.01; 95% confidence interval 1.27-3.37). These data suggest a significant association between colonization with U. urealyticum and CLD in infants weighing < 1,500 g.     

Ureaplasma urealyticum infection in newborns: Three case reports

We report three newborns with different manifestations ofUreaplasma urealyticum infection; a term newborn with acute neonatal pneumonia and two very low birth weight infants with bronchopulmonary dysplasia and osteomyelitis of the femur, respectively. The association ofU. urealyticum with acute and chronic respiratory disease in term and preterm newborns has recently been reported. Our two cases are similar to other case reports from the literature, but we were unable to find any previous reports of osteomyelitis due toU. urealyticum in the premature babies. Isolation ofU. urealyticum in pure culture from the blood was considered to be related to local infection in all three patients. All patients were cured by erythromycin.     

Clinical relevance of Ureaplasma urealyticum colonization in preterm infants

A cohort of 78 infants of gestational age less than 34 weeks was examined for Ureaplasma urealyticum colonization and neonatal morbidity. Ureaplasma urealyticum was cultured from nasopharyngeal, endotracheal and blood-culture samples. A child was considered as being colonized if any sample was positive. The children with perinatal U. urealyticum colonization (n = 11; 14%) differed from those with no colonization (n = 67) in two important aspects: (i) they had higher leucocyte counts on the first (18.6 vs 12.4 109) and the second (29.0 vs 15.4 109) days of life ( p = 0.01, both days); and (ii) they more often needed high-frequency oscillatory ventilation (45% vs 13%, p = 0.02). This study showed that U. urealyticum colonization is associated with signs of the host defence response together with symptoms of respiratory tract involvement suggesting the pathogenicity of U. urealyticum in premature infants.     

新生儿支原体感染情况的初步观察

为了探讨致病性支原体对新生儿的影响，采用间接血细胞凝集方法检测了３２３例住院新生儿血清中支原体特异抗体。结果：３２３例中５６例阳性，阳性率１７．３％。其中解脲脲原体２６例，阳性率４６．４％，人型支原体１６例，占２８．６％，二者合计４２例，占７５．０％。３３例做了双份血清抗体检测，１７例抗体阳性，并且两次间抗体滴度有变化，其中９例阳性转为阴性，７例阴性转为阳性，１例滴度继续升高。检测了１９例早产儿，阳性６例，阳性率３１．６％。所有支原体抗体阳性新生儿未见特异症状和体征，与原病种无明显关系。提示：新生儿对支原体的感染，以解脲脲原体和人型支原体为主，早产儿感染率相对较高。由于感染和检测时间的早晚，一次抗体阴性不能除外支原体感染。     

新生儿痰真菌生长的临床意义及相关因素探讨

目的探讨新生儿痰真菌生长的临床意义及相关因素。方法回顾性分析149例诊断为新生儿肺炎且痰培养结果阳性住院新生儿的临床资料,根据痰培养结果将患儿分为真菌组、混合组和细菌组,运用Х^2检验及方差分析等统计学方法,比较三组的临床资料。结果（1）真菌组40例、混合组30例和细菌组79例,痰真菌生长占47．0％（70／149）。（2）三组间白细胞数分别为（10．3±3．5）×10^9／L、（11．7±5．2）×10^9／L和（14．4±10．5）×10^9／L,F=3．78,P=0．03;中性粒细胞数分别为（5．1±3．3）×10^9／L、（7．4±4．7）×10^9／L、（9．0±7．4）×10^9／L,F=5．50,P=0．01;下列因素所占比例,三组分别为：早产儿32．5％（13／40）、20％（6／30）和12．7％（10／79）,Х^2=6．68,P=0．04;母产前使用糖皮质激素10．0％（4／40）、6．7％（2／30）和0％（0／79）,P=0．01;使用三联抗生素治疗10．0％（4／40）、16．7％（5／30）和2．5％（2／79）,P=0．02;碳青霉烯类药物治疗32．5％（13／40）、63．3％（19／30）和17．7％（14／79）,Х^2=21．26,P=0．00。上述6个因素三组间差异均有显著统计学意义。（3）以痰真菌生长作为因变量进行Logistic回归分析,共2个变量进入最佳回归方程：碳青霉烯类药物（克倍宁或泰能）治疗（X1）、早产儿（X2）,建立影响痰真菌生长的主效应模型Logistic（SCF）=β0（0．12）＋1．63X1＋1．20X2（Х^2=43．04,P〈0．05）。（4）仅一次痰真菌生长,抗真菌治疗与否未愈率分别为10．0％（2／22）和0％（0／43）,P=0．111;继续住院时间分别为（225．8±7．7）d和（434．1±4．7）d,t=1．095,P=0．278,均无统计学意义。结论（1）在新生儿肺炎中,痰真菌生长比较普遍,以白色念珠菌为主。（2）早产儿、碳青霉烯类抗生素治疗可作为痰真菌生长的独立危险因素。（3）仅一次痰真菌生长只提示需作进一步真菌检查,不能凭此确诊肺部真菌感染或决定是否抗真菌治疗。     

新生儿和婴儿呼吸道合胞病毒致急性下呼吸道感染临床特征和疾病负担

目的了解上海地区新生儿和婴儿呼吸道合胞病毒（RSV）感染的严重程度及疾病负担,为RSV感染的监测及临床防治提供科学依据。方法回顾性收集2012年3月至2013年2月复旦大学附属儿科医院内科和新生儿科住院并确诊为急性下呼吸道感染（ALRI）≤1岁患儿的病历,截取人口学资料、临床特征、病死率、并发症、住院时间和费用等指标,并采用严重度指数(SI)进行RSV感染严重程度综合评价。分为新生儿组和婴儿组,并进一步分为单一感染和混合感染亚组进行分析。 结果1 726例ALRI≤1岁患儿中RSV阳性913例（52.9%）进入分析。新生儿组295例,婴儿组618例。①SI评分新生儿组高于婴儿组,(2.5±0.2) vs (1.9±0.1)分,P<0.05;较重度和重度比例新生儿组显著高于婴儿组,但单一感染和混合感染亚组间差异无统计学意义。②RSV感染的≤1岁患儿病死率为5.0％,新生儿组病死率与婴儿组差异无统计学意义,婴儿组合并基础疾病患儿病死率高。③机械通气比例两组间差异无统计学意义,婴儿组混合感染亚组高于单一感染亚组。④并发症情况：新生儿组呼吸暂停和脓毒症发生率较高,新生儿组混合感染亚组脓毒症发生率显著高于单一感染亚组。⑤住院天数新生儿组与婴儿组差异无统计学意义,合并基础疾病者显著高于未合并疾病疾病患儿;住院费用婴儿组显著高于新生儿组,新生儿混合感染亚组显著高于单一感染亚组,合并基础疾病患儿显著高于未合并基础疾病患儿。 结论RSV感染新生儿的重症比例和并发症的发生率较高,婴儿组住院费用较高。混合感染和合并基础疾病是影响RSV感染严重程度和疾病负担的重要因素。