新生儿败血症合并早期弥散性血管内凝血相关因素的临床研究

目的 探讨新生儿败血症合并早期弥散性血管内凝血(DIC)的相关临床因素,为临床早期诊断新生儿败血症合并DIC 提供参考。方法 采用临床回顾研究方法对我院NICU 2012~2013 年确诊为新生儿败血症的100 例患儿进行研究。根据ISTH 显性DIC 评分系统将患儿分为凝血功能正常组、非显性DIC 组(早期DIC 组)及显性DIC 组(晚期DIC 组),对各组临床表现及相关临床因素进行统计分析。结果 100 例败血症患儿中合并早期DIC 者44 例(44%);3 组患儿硬肿的发生率差异有统计学意义(χ2=12.776,P<0.05);窒息、出血及G- 菌感染是败血症合并早期DIC 的独立危险因素。结论 对于临床有窒息、出血及G- 菌感染的新生儿应积极监测凝血功能并采取早期干预措施,预防患儿由早期DIC 进展为晚期DIC,降低新生儿败血症的病死率。     

Clinical characteristics and risk factors for early-onset necrotizing enterocolitis in preterm infants with very/extremely low birth weight北大核心CSCD

Objective To investigate the clinical characteristics and risk factors for early-onset necrotizing enterocolitis (NEC) in preterm infants with very/extremely low birth weight (VLBW/ELBW). Methods A retrospective analysis was performed on the medical data of 194 VLBW/ELBW preterm infants with NEC who were admitted to Children's Hospital Affiliated to Zhengzhou University from January 2014 to December 2021. These infants were divided into early-onset group (onset in the first two weeks of life; n=62) and late-onset group (onset two weeks after birth; n=132) based on their onset time. The two groups were compared in terms of perinatal conditions, clinical characteristics, laboratory examination results, and clinical outcomes. Sixty-two non-NEC infants with similar gestational age and birth weight who were hospitalized at the same period as these NEC preterm infants were selected as the control group. The risk factors for the development of early-onset NEC were identified using multivariate logistic regression analysis. Results Compared with the late-onset group, the early-onset group had significantly higher proportions of infants with 1-minute Apgar score ≤3, stage III NEC, surgical intervention, grade ≥3 intraventricular hemorrhage, apnea, and fever or hypothermia (P<0.05). The multivariate logistic regression analysis showed that feeding intolerance, blood culture-positive early-onset sepsis, severe anemia, and hemodynamically significant patent ductus arteriosus were independent risk factors for the development of early-onset NEC in VLBW/ELBW preterm infants (P<0.05). Conclusions VLBW/ELBW preterm infants with early-onset NEC have more severe conditions compared with those with late-onset NEC. Neonates with feeding intolerance, blood culture-positive early-onset sepsis, severe anemia, or hemodynamically significant patent ductus arteriosus have a higher risk of early-onset NEC. © 2023 Xiangya Hospital of CSU. All rights reserved.     

先天性念珠菌败血症6例临床分析

目的探讨先天性念珠菌败血症的临床及实验室检查特征, 为临床早期治疗该病提供参考。方法回顾性分析郑州大学附属儿童医院2016年10月1日至2021年12月31日收治的6例诊断为先天性念珠菌败血症患儿的临床特征、实验室结果及诊治经过, 并对菌株进行药物敏感试验。结果 6例患儿中, 男4例, 女2例, 胎龄为26+1至31+2周, 出生体质量为850～1 490 g, 入院日龄为1～5 d。5例阴道分娩, 1例剖宫产, 试管婴儿3例。母亲妊娠期念珠菌性阴道炎6例, 宫颈环扎术2例, 宫颈息肉摘除术1例。6例患儿发病时均有呼吸窘迫和腹胀, 同时伴高血糖(5例)、肝肿大(4例)、感染性休克(3例)等。实验室检查结果示:外周血白细胞计数升高者4例, 白细胞计数减少伴中性粒细胞计数<1.0×109/L者2例, C反应蛋白水平均升高, 血小板计数均减少。血培养检出念珠菌的时长为36～50 h, 5例血培养检出白念珠菌, 1例血培养检出光滑念珠菌, 3例脑脊液培养检出白念珠菌。药物敏感试验结果示:光滑念珠菌对氟康唑耐药, 对两性霉素B敏感;白念珠菌对氟康唑和两性霉素B均敏感。6例患儿中, 4例治愈...     

新生儿监护室院内感染发生率与危险因素分析

目的：统计新生儿监护室院内感染发生率，并分析其危险因素。方法：选取新生儿监护室2021年1月至2022年6月收治的新生儿患儿70例作为研究对象，统计其院内感染发生情况、病原菌分布情况、主要病原菌耐药情况，并对新生儿监护室多重耐药菌感染的危险因素展开分析。结果：70例患儿中院内感染发生率由高到低排序分别为上呼吸道感染（25.71%）、下呼吸道感染（20.00%）、消化道感染（15.71%）、血液系统感染（14.29%）、泌尿系统感染（11.43%）及其他（12.86%）。在36例阳性感染患儿中共检出36株病原菌毒株，包括24株革兰氏阴性菌（66.67%）、12株革兰氏阳性菌（33.33%）。主要革兰氏阴性菌为大肠埃希菌、肺炎克雷伯菌，均对头孢曲松有着较高的耐药率，分别为87.50%、83.33%；主要革兰氏阳性菌为金黄色葡萄球菌、凝固酶阴性葡萄球菌，均对青霉素有着较高的耐药率，分别为100.00%、75.00%。Logistic回归分析结果显示，新生儿监护室多重耐药菌感染的危险因素包括新生儿出生时体质量＜1.5 kg、抗菌药物使用时间＞2周及抗菌药物联用。结论：新生儿监护室院内感染事件的发生存在诸多危险因素，一旦出现院内感染，将会导致治疗难度明显上升。故在日常医学操作中，医护人员要注重手部清洁度，尽量避免有创性操作的实施，同时定期严格进行室内消毒并做好感染监测工作，最大限度降低院内感染事件发生风险，确保新生儿身体健康。