Identification of Extremely Premature Infants at Low Risk for Early-Onset Sepsis
Identification of Extremely Premature Infants at Low Risk for Early-Onset Sepsis
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DOI：
10.1542/peds.2017-0925
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发表时间：
2017-11-01
期刊：
影响因子：
8
通讯作者：
Wyckoff, Myra H.
中科院分区：
文献类型：
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作者：
Puopolo, Karen M.;Mukhopadhyay, Sagori;Wyckoff, Myra H.
背景技术背景：早产儿相对于足月儿而言，早发性脓毒症（EOS）的风险较高，大多数早产儿在出生后接受经验性抗生素治疗。我们的目的是确定出生时明显的因素是否可以用于识别早产儿的低风险EOS.METHODS：研究婴儿出生在22至28周的新生儿研究网络中心从2006年到2014年的妊娠。EOS的定义是从血液或脑脊液培养物中分离出致病菌（≥ 5天），并在低风险婴儿和所有其他婴儿之间进行比较。死亡率，EOS，和其他发病率的风险进行了评估，通过使用回归模型调整中心，种族，产前类固醇使用，多胞胎，性别，妊娠，和出生weight.RESULTS：15 433名婴儿，5759（37%）符合低风险标准。低危组存活>12小时的婴儿中EOS发生率为29/5640（0.5%），对照组为209/8422（2.5%）（校正相对危险度= 0.24 [95%置信区间，0.16-0.36]）。低风险婴儿EOS或死亡= 12小时的综合风险也显著降低。长期抗生素管理的低风险婴儿的34%与47%的比较婴儿没有EOS.CONCLUSIONS：极端早产儿的分娩特点，可用于确定那些EOS的发病率显着降低。认识到不同的风险可能有助于指导决策，以限制这些婴儿中约三分之一的早期抗生素使用。
BACKGROUND: Premature infants are at high risk of early-onset sepsis (EOS) relative to term infants, and most are administered empirical antibiotics after birth. We aimed to determine if factors evident at birth could be used to identify premature infants at lower risk of EOS.METHODS: Study infants were born at 22 to 28 weeks' gestation in Neonatal Research Network centers from 2006 to 2014. EOS was defined by isolation of pathogenic species from blood or cerebrospinal fluid culture at = 5 days) was compared between low-risk infants and all others. Risks of mortality, EOS, and other morbidities were assessed by using regression models adjusted for center, race, antenatal steroid use, multiple birth, sex, gestation, and birth weight.RESULTS: Of 15 433 infants, 5759 (37%) met low-risk criteria. EOS incidence among infants surviving >12 hours was 29 out of 5640 (0.5%) in the low-risk group versus 209 out of 8422 (2.5%) in the comparison group (adjusted relative risk = 0.24 [95% confidence interval, 0.16-0.36]). Low-risk infants also had significantly lower combined risk of EOS or death = 12 hours. Prolonged antibiotics were administered to 34% of low-risk infants versus 47% of comparison infants without EOS.CONCLUSIONS: Delivery characteristics of extremely preterm infants can be used to identify those with significantly lower incidence of EOS. Recognition of differential risk may help guide decisions to limit early antibiotic use among approximately one-third of these infants.