Late-onset sepsis in very low birth weight neonates: A report from the National Institute of Child Health and Human Development Neonatal Research Network
Late-onset sepsis in very low birth weight neonates: A report from the National Institute of Child Health and Human Development Neonatal Research Network
复制标题
DOI：
10.1016/s0022-3476(96)70191-9
复制
发表时间：
1996-07-01
影响因子：
5.1
通讯作者：
Wright, LL
中科院分区：
文献类型：
--
作者：
Stoll, BJ;Gordon, T;Wright, LL
目的：迟发性脓毒症（发生在出生后3天）是极低出生体重儿（VLBW）的一个重要问题。为了确定迟发性脓毒症的当前发病率、疾病的危险因素以及迟发性脓毒症对随后住院过程的影响，我们评估了一个7861例VLBW的队列（401至1500克）新生儿入院的12个国家儿童健康和人类发展研究所（NICHD）新生儿研究网络中心在32个月的时间内方法：NICHD新生儿研究网络对参与中心的所有VLBW新生儿进行前瞻性登记。对该登记研究的数据进行了回顾性分析。结果：在6911名存活超过3天的婴儿中，1696名（25%）有一次或多次血培养证实的败血症发作。绝大多数感染（73%）由革兰氏阳性菌引起，凝固酶阴性葡萄球菌占所有感染的55%。感染率与出生体重和胎龄呈负相关。与感染率增加相关的早产儿并发症包括插管、呼吸窘迫综合征、长时间通气、支气管肺发育不良、动脉导管未闭、严重脑室内出血和坏死性小肠结肠炎。在支气管肺发育不良的婴儿中，迟发性脓毒症的婴儿机械通气持续时间明显较长（45天vs 33天; p < 0.01）。迟发性脓毒症延长住院时间：伴和不伴迟发性脓毒症的极低出生体重新生儿平均住院天数分别为86天和61天（p < 0.001）。即使校正了早产儿的其他并发症，包括脑室内出血、坏死性小肠结肠炎和支气管肺发育不良，晚发性败血症婴儿的住院时间也明显延长（p < 0.001）。此外，发生迟发性败血症的新生儿比未感染的新生儿更容易死亡（17% vs 7%; p < 0.0001），特别是如果他们感染了革兰氏阴性菌（40%）或真菌（28%）。而在生命的前3天，只有4%的死亡归因于感染，45%的死亡2周后与infection.Conclusions：迟发性败血症是一个常见的和重要的问题VLBW早产儿。减少迟发性脓毒症的成功策略应降低VLBW死亡率，缩短住院时间并降低费用。
Objective: Late-onset sepsis (occurring after 3 days of age) is an important problem in very low birth weight (VLBW) infants. To determine the current incidence of late-onset sepsis, risk factors for disease, and the impact of late-onset sepsis on subsequent hospital course, we evaluated a cohort of 7861 VLBW (401 to 1500 gm) neonates admitted to the 12 National Institute of Child Health and Human Development (NICHD) Neonatal Research Network centers during a 32-month period (1991 to 1993).Methods: The NICHD Neonatal Research Network maintains a prospectively collected registry of all VLBW neonates cared for at participating centers. Data from this registry were analyzed retrospectively. Results: Of 6911 infants who survived beyond 3 days, 1696 (25%) had one or more episodes of blood culture-proven sepsis. The vast majority of infections (73%) were caused by gram-positive organisms, with coagulase-negative staphylococci accounting for 55% of all infections. Rate of infection was inversely related to birth weight and gestational age. Complications of prematurity associated with an increased rate of infection included intubation, respiratory distress syndrome, prolonged ventilation, bronchopulmonary dysplasia, patent ductus arteriosus, severe intraventricular hemorrhage, and necrotizing enterocolitis. Among infants with bronchopulmonary dysplasia, those with late-onset sepsis had a significantly longer duration of mechanical ventilation (45 vs 33 days; p < 0.01). Late-onset sepsis prolonged hospital stay: the mean number of days in the hospital for VLBW neonates with and without late-onset sepsis was 86 and 61 days, respectively (p < 0.001). Even after adjustment for other complications of prematurity, including intraventricular hemorrhage, necrotizing enterocolitis, and bronchopulmonary dysplasia, infants with late-onset sepsis had a significantly longer hospitalization (p < 0.001). Moreover, neonates in whom late-onset sepsis developed were significantly more likely to die than those who were uninfected (17% vs 7%; p < 0.0001), especially if they were infected with gram-negative organisms (40%) or fungi (28%), Deaths attributed to infection increased with increasing chronologic age. Whereas only 4% of deaths in the first 3 days of life were attributed to infection, 45% of deaths after 2 weeks were related to infection.Conclusions: Late-onset sepsis is a frequent and important problem among VLBW preterm infants. Successful strategies to decrease late-onset sepsis should decrease VLBW mortality rates, shorten hospital stay, and reduce costs.