日本新生儿重症监护病房研修见闻

1998年 5月～ 1999年 5月 ,我到日本信州大学 (简称信大 )医学部附属医院研修新生儿急救 (ＮＩＣＵ)专业 ,并到长野县儿童医院进行短期参观。对其先进的医疗设施、诊疗技术及科学严谨的病房管理制度留下了深刻的印象。一、ＮＩＣＵ的管理信大医学部附属医院ＮＩＣＵ使人感受最深的是无菌管理制度。房间的门窗密封良好 ,屋顶装有空气净化除菌装置 ,经此装置进入室内的新鲜空气自由菌数为零。屋顶边缘装有排气装置 ,将陈旧空气排出室外 ,形成良好的空气循环。工作人员的入室程序是维持室内清洁无菌的主要环节。进入ＮＩＣＵ须经过三道门 :第一…     

新生儿重症监护病房噪音对新生儿的影响

新生儿重症监护病房是集中诊治重症新生儿和对高危儿进行监护的医疗单元,医疗设备多,噪音难免.探索噪音对新生儿影响具有重要意义.近年来国内外对噪声引起新生儿听力损伤的机制,对新生儿生理和神经行为的发育及对中枢系统的影响研究较多.文章就此予以综述.     

新生儿重症监护病房早产儿脑室内出血的临床分析及防治

目的探讨新生儿重症监护病房(NICU)早产儿脑室内出血(IVH)的发病因素及防治。方法回顾分析2000年1月至2006年3月我院NICU早产儿临床资料,生后3～7d内头颅B超检查情况。结果480例早产儿,脑室内出血160例,发生率达33.3%,与出生胎龄、出生体重呈负相关,与窒息、缺氧、感染、贫血等并发症程度呈正相关。结论IVH与胎龄、出生体重、窒息、缺氧、感染、贫血、机械通气密切相关,综合防治可减少IVH发生率,提高早产儿,尤其是极低体重儿的抢救成功率、避免或减少后遗症的发生。     

新生儿重症监护病房早产儿脑室内出血的临床分析及防治

目的 探讨新生儿重症监护病房（NICU）早产儿脑室内出血（IVH）的发病因素及防治。方法 回顾分析2000年1月至2006年3月我院NICU早产儿临床资料，生后3～7d内头颅B超检查情况。结果 480例早产儿，脑室内出血160例，发生率达33．3％，与出生胎龄、出生体重呈负相关，与窒息、缺氧、感染、贫血等并发症程度呈正相关。结论 IVH与胎龄、出生体重、窒息、缺氧、感染、贫血、机械通气密切相关，综合防治可减少IVH发生率，提高早产儿，尤其是极低体重儿的抢救成功率、避免或减少后遗症的发生。     

新生儿重症监护病房噪音对新生儿听力的影响

近年来,由于新生儿重症监护病房（the neonatal intensive care unit,NICU）技术的进步,住院新生儿存活率显著升高,有关噪音对NICU新生儿的影响越来越受到包括医学界在内的社会各界的关注。     

重症监护病房新生儿深部真菌感染临床特点分析

目的 提高新生儿深部真菌感染的临床诊断及经验性治疗水平.方法 选取2008年1月 - 2010年12月期间NICU住院确诊深部真菌感染的21例新生儿为研究对象,分析患儿的临床表现、实验室结果、基础疾病、真菌类别,以及抗真菌治疗效果.结果 患儿基础疾病以肺部疾病最多见,占47.6%;外科手术治疗5例,占23.8%,其中腹部手术者4例.临床表现以喂养不耐受、呼吸暂停、发热和反应差最多见,有19例(90.5%)出现血小板减低,19例(90.5%)超敏CRP增高,白细胞正常13例(61.9%).其中确诊真菌败血症18例(85.7%),真菌脑炎1例(4.8%),尿路感染2例(9.5%).病原菌均为假丝酵母菌.用氟康唑及两性霉素B脂质体治疗,总治愈率71.4%,好转19.1%,死亡9.5%.结论 喂养不耐受、发热、呼吸暂停和反应差是深部真菌感染患儿最多见的临床表现;患儿多数表现有血小板减低及超敏CRP增高,白细胞正常不能排除该病;近平滑假丝酵母菌感染最多见,白假丝酵母菌次之.     

儿童重症监护病房侵袭性真菌感染38例临床分析

目的：探讨儿童重症监护病房（PICU）侵袭性真菌感染（IFI）的临床特征,为其有效防治提供依据。方法：回顾性分析38例IFI患儿的临床特征及治疗转归情况。结果：38例患儿中,以呼吸道感染最多见（89%）;感染前均有较严重的基础疾病,且使用过多种抗生素,其中碳青霉烯类抗生素使用率高达95%;47%患儿曾全身激素治疗;所有患儿均有侵入性操作史,其中47%患儿接受过气管插管及机械通气治疗;所有患儿临床症状及体征不典型,影像学检查无特异性。真菌培养共检出致病真菌56株,以白色念珠菌为主（41%）,其次为曲霉菌（25%）和毛霉菌（20%）;所有患儿及时予以高效抗真菌药物治疗,治愈15例,好转16例,有效率为82%,不良反应发生率为16%。结论：呼吸道为最常见IFI感染部位;白色念珠菌为主要病原;多数患儿有严重基础疾病、广谱抗生素及糖皮质激素的使用史和侵入性操作史;早期诊断、及时使用高效抗真菌药物可改善预后。     

新生儿重症监护病房侵袭性真菌感染易感因素及早期诊断探讨

目的 探讨新生儿侵袭性真菌感染的易感因素及早期诊断措施.方法 对24例新生儿侵袭性真菌感染的高危因素、临床资料及治疗预后进行回顾性分析.结果 2009年1月1日 - 2010年12月31日新生儿重症监护病房(NICU)收治新生儿真菌感染24例,占NICU 同期收治新生儿0.66%(24/3 635).210例同时做血培养和(1,3)-β-D葡聚糖含量检测,送检率5.8%(210/3 635);(1,3)-β-D葡聚糖阳性24例,阳性率11.4%(24/210);血培养阳性8例,阳性率3.8%(8/210),(1,3)-β-D葡聚糖阳性率显著高于血培养阳性率(P ＜ 0.05).病原菌中念珠菌5例(光滑念珠菌3例,热带念珠菌1例,克柔念珠菌1例),白假丝酵母菌2例,毛霉菌1例,对氟康唑等常用抗真菌药均敏感.24例侵袭性真菌感染新生儿均联合应用三代头孢菌素7 d以上(100.0%),早产儿20例(83.3%),气管插管机械通气19例(79.2%),留置中心静脉导管17例(70.8%).早产、低出生体质量、留置中心静脉导管、气管插管机械通气及长期联合使用广谱抗生素为新生儿侵袭性真菌感染的高危因素.结论 新生儿侵袭性真菌感染以早产儿为主,病原菌以念珠菌为主;(1,3)-β-D葡聚糖含量检测在新生儿侵袭性真菌感染的早期诊断中敏感性高、特异性强,动态观察更容易早期发现异常.临床上合理使用抗生素,及时检测(1,3)-β-D葡聚糖含量,有利于NICU中新生儿侵袭性真菌感染的早期诊断和减少误诊漏诊率.     

儿童重症监护病房侵袭性真菌感染的临床特点

目的探讨儿童重症监护病房(PICU)侵袭性真菌感染(IFI)的临床特点及危险因素。方法回顾性分析2009年5月-2011年5月本院PICU收治的41例IFI患儿的临床资料,总结其易感因素、临床表现、辅助检查、治疗及预后。结果 PICU共收治患儿2 013例,其中41例发生IFI,发生率为2.04%;死亡8例,病死率为19.51%。其中84.6%为念珠菌属。感染部位:呼吸系统29例,消化系统4例,泌尿系统3例,中枢神经系统3例,血液系统2例。危险因素有危重症评分、机械通气、中心静脉置管、尿管留置。易感因素有广谱抗生素应用、激素、低蛋白血症、化疗等。结论念珠菌属是PICU发生IFI的主要病原,合理使用抗生素、限制激素应用、减少或缩短不必要的侵入性操作及合理使用抗真菌药物,是降低IFI发病率、提高抢救成功率的有效策略。     

新生儿重症监护病房噪音对早产儿听力影响的研究

目的 探讨新生儿重症监护病房(NICU)噪音对高危早产儿的听力损害.方法 使用B&K2231精密积分声级计,累计测量NICU开放暖床及培育箱中噪音24 h,将其分为安静时间段和嘈杂时间段,记录其噪音分布情况.研究对象为早产极低出生体重儿,将培育箱中养育20例为观察组和开放暖床中20例为对照组.在住院1个月时,分别作瞬态诱发性耳声发射(TEOAE)和脑干听觉诱发电位(ABR)两项听力检查.结果 安静时间段和嘈杂时间段时间比例约为3,安静时间段培育箱中噪音(55.3±1.2)dB与开放暖床中噪音(55.0±1.6)dB比较,P=0.179,差异无统计学意义;嘈杂时间段培育箱中噪音(58.6±3.3)dB与开放暖床中噪音(61.7±2.1)dB比较,P=0.000,差异有统计学意义.1个月龄时,做TEOAE和ABR检查,观察组总反应能量较对照组高1.5 dB SPL,P=0.033,差异有统计学意义;Ⅰ～Ⅴ波间期观察组缩短0.35ms,P=0.032差异有统计学意义;40例患儿均通过,各项指标显示观察组患儿优于对照组患儿.结论 低噪音环境更有利于早产极低出生体重儿听觉系统发育.     

新生儿侵袭性真菌感染

侵袭性真菌感染(invasive fungal infection,IFI)是早产儿致死和致残的重要原因。新生儿IFI的发生涉及宿主因素(如超未成熟早产儿、极低出生体重、免疫功能低下、真菌定植等)与外在因素(如中心静脉置管、机械通气、肠外营养、广谱抗生素应用等)。新生儿IFI临床表现无特异性,容易与晚发型细菌败血症混淆...     

新生儿侵袭性真菌感染的临床特点分析

目的 分析新生儿侵袭性真菌感染的临床特点,以提高该病的诊治水平,降低漏诊率.方法 收集我院2012年1月至2015年3月新生儿病房收治的66例确诊侵袭性真菌感染患儿的临床资料,对患儿的一般情况、发病时间、首发症状、实验室检查、血培养结果、治疗转归、随访情况进行回顾性分析.结果 侵袭性真菌感染的平均发病日龄为(18.6 ±9.1)d;临床表现不典型,以呼吸暂停、喂养不耐受、发热、精神反应差、活动少为首发症状;实验室检查表现为血小板减少及C-反应蛋白增高、(1,3)-β-D葡聚糖增高;血培养以念珠菌为主;氟康唑治疗效果好.结论 新生儿真菌感染临床表现缺乏特异性,对有高危因素的患儿需高度警惕真菌感染的可能,早期诊断、及时治疗是治疗成功的关键.     

呼吸道真菌定植与侵袭性真菌感染的识别

侵袭性真菌感染在重症患者中的发病率逐年上升,其临床表现缺乏特异性,早期诊断困难,临床难以与呼吸道真菌定植鉴别。因此需要探讨早期识别的方法。     

Risk factors for invasive fungal infection in neonates

Invasive fungal infection is an uncommon, but increasing cause of morbidity and mortality in neonates. There are few controlled studies defining risk factors for the development of fungal infection in a contemporary neonatal population. This retrospective case-control study was undertaken to investigate antenatal, demographic and postnatal variables that may be potentially important in the development of fungal infection. Two gestation-matched controls were identified for each index case. Information about perinatal and demographic variables, as well as important neonatal outcomes, was obtained from case notes. Microbiological data collected included the presence of fungal colonization, and organisms responsible for invasive fungal infection. Over a 5-y period, 24 infants with invasive fungal infection and 48 controls were identified. Candida albicans was the organism identified in 75% of cases of fungal septicaemia, and in all cases complicated by fungal meningitis. Preceding fungal colonization, pulmonary haemorrhage and intrauterine growth restriction were factors significantly and independently associated with invasive fungal infection. Fifty-four percent of infants with invasive fungal infection died, and 82% of survivors developed chronic lung disease.

Conclusion : Some new and potentially important risk factors for the development of invasive fungal infection in a contemporary population of infants admitted to a neonatal intensive care were identified.     

160例新生儿真菌性肺炎的高危因素分析

目的：探讨新生儿真菌性肺炎的相关高危因素。方法：将260例院内感染性肺炎分为真菌性肺炎组和非真菌性肺炎组。分别对每组病例一般情况、抗生素的应用、原发病等因素进行分析。结果：①在住院天数、是否早产、体重方面两组差异显著。②使用第三代头孢菌素+酶抑制剂、半合成青霉素+酶抑制剂、碳青酶烯类，联合使用两种广谱抗菌药物和抗生素总的使用天数在医院获得性真菌性肺炎组使用时间较细菌组长,差异有统计学意义。③新生儿真菌性肺炎的原发病多为医院获得性细菌性肺炎,二者有高度的相关性。结论：早产儿、低体重儿、住院时间长、长时间使用抗生素包括三代头孢类抗菌药物、两种抗生素联合应用或碳青酶烯类抗菌药物可增加医院感染性真菌性肺炎发生的危险性。新生儿真菌性肺炎的发生和新生儿医院获得性细菌性肺炎有相关性。     

无基础疾病儿童侵袭性真菌病的临床研究

目的 探讨无基础疾病儿童侵袭性真菌病 （IFD） 的临床特点。方法 回顾性分析49例无基础疾病侵袭性真菌病患儿的临床资料。结果 无基础疾病侵袭性真菌病儿童的病原检出率为76% （37/49）,其中新型隐球菌 （17例,46%）、白色假丝酵母菌 （10例,27%）、曲霉菌及近平滑假丝酵母菌 （各3例,均占8%） 为最常见的病原。真菌性肺炎最多见 （17例,46%）,病原以白色假丝酵母菌为主 （9例,53%）。49例患儿均存在至少一项感染高危因素,主要为抗生素使用、长时间住院以及侵袭性操作。行G试验检查的24例中17例阳性 （71%）。49例患儿均接受抗真菌治疗,37例 （75%） 治愈,3例 （6%） 仍在治疗中,5例 （10%） 死亡,4例 （8%） 失访。结论 对于无基础疾病的IFD患儿,新型隐球菌、念珠菌为其主要病原,肺部感染最为多见。长期大量使用抗生素是较突出危险因素。无基础疾病的IFD患儿对于抗真菌药物敏感,预后较好。     

NICU中新生儿呼吸机相关性肺炎202例临床分析

目的研究NICU中呼吸机相关性肺炎(VAPN)的发病情况及其临床特点。方法回顾性对比分析空气层流净化NICU建立前后苏州儿童医院VAPN的发病率、病原学、易感因素及预防对策。结果NICU建立后VAPN的发生率有明显下降(17.70％vs47.19％,P<0.05);VAPN仍是呼吸机治疗失败的主要原因;VAPN的病原菌主要为耐药性细菌、条件性致病菌和真菌;VAPN的主要易感因素为呼吸机使用时间、患儿胎龄及抗生素使用时间。结论加强NICU中空气净化和无菌操作、控制呼吸机和抗生素的使用时间是降低新生儿呼吸机相关性肺炎的发生、提高危重新生儿抢救成功率的关键。     

Fluconazole prophylaxis prevents invasive fungal infection in high-risk, very low birth weight infants

OBJECTIVES: To evaluate the benefit of fluconazole prophylaxis in preventing invasive fungal infection in very low birth weight (VLBW) infants with central vascular access. STUDY DESIGN: A 3-year baseline period (1998 to 2000) was compared with a subsequent 3-year period (2001 to 2003) during which a different protocol for preventing invasive fungal infection was used. All infants with a birth weight < 1500 g and with central vascular access were eligible for the study. Fluconazole (Diflucan R) was administered for 28 days at a dose of 6 mg/kg every third day during the first week and daily after the first week. RESULTS: There were no significant differences between the baseline and the fluconazole groups in demographic characteristics or risk factors for fungal infection. Fungal infection developed in 9 of the infants in the baseline group and in none of those in the fluconazole group (P=.003). A trend of decreasing mortality rate between the 2 groups (12.6% vs 8.1%; P=.32) was observed but was not statistically significant. No adverse effects of fluconazole therapy were documented. CONCLUSIONS: Fluconazole prophylaxis appeared to be beneficial in preventing invasive fungal infection in VLBW infants.     

Infection prevention for extremely low birth weight infants in the NICU

Extremely preterm infants are particularly vulnerable to systemic infections secondary to their immature immune defenses, prolonged hospitalizations, delays in enteral feeding, early antibiotic exposure, and need for life-sustaining invasive interventions. There have been several evidence-based practices for infection prevention in this population, such as human milk feedings, utilization of “bundle checklists” and decolonization of pathogenic organisms. Other practices, such as the use of probiotics, human milk-derived fortifiers, and antifungal prophylaxis are more controversial and require further investigation regarding the risks and benefits of such interventions.This chapter examines the susceptibility of the preterm newborn infant to invasive infections and describes several strategies for infection prevention, along with the associated limitations of such practices. It also addresses the various gaps in our understanding of preventing infections in this population, and the need for additional large multi-center randomized controlled trials. Additionally, the role of the SARs-CoV-2 global pandemic and associated strategies for infection prevention in the NICU are discussed.     

NICU in a community level hospital

Objective: To study the clinical profile and outcome of neonates in NICU of a community hospital and highlight the importance and problems in neonatal care at a community level hospital.Methods: Retrospective analysis of case records during the period Jan. 2001–Dec. 2003. Data regarding antenatal care, maternal morbidity, place of birth, age at admission, birth weight, gestational age, diagnosis, relevant investigations, duration of stay and outcome were recorded on a preset proforma. A cost analysis for average expenses per newborn per day for different morbidities was also done. Neonatal data was analyzed among survivors and expired using approapriates statistical tests. Probability of less than 5% was taken significant. Factors found significant on univariate analysis were subjected to logistic regression model to study independent predictor of fatality.Results: A total of 168 neonates were admitted during the study period. The overall survival rate was 65%. 42(25%) neonates expired and 5.4% were referred to higher centers. The commonest morbidity in survivors was hyperbilirubinemia. Prematurity with HMD and neonatal sepsis were the commonest cause of mortality. 36(24.3%) expired within 48 hr of admission (Mean 33.2 hr). 31(17.8%) could not be referred and none survived. The difference of birth weight, gestational age and duration of stay was statistically different in survivors & expired. These variables retained their significance on multivariate analysis and thus were independent predictors of fatality. An average expense of Rs 400–500/day/newborn was charged in the NICU.Conclusion: In a country of limited resource 65% neonates requiring NICU can be managed at community level hospitals.