Antibiotic Therapy for Very Low Birth Weigh Newborns in NICU.
Antibiotic Therapy for Very Low Birth Weigh Newborns in NICU.
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DOI：
10.5812/ijp.2612
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发表时间：
2016-04
影响因子：
0.5
通讯作者：
Esmaili F
中科院分区：
文献类型：
--
作者：
Afjeh SA;Sabzehei MK;Fahimzad SA;Shiva F;Shamshiri AR;Esmaili F
新生儿长期经验性抗生素治疗会导致多种不良后果，包括广泛的抗生素耐药性、迟发性败血症 (LOS)、坏死性小肠结肠炎 (NEC)、住院病程 (HC) 延长和死亡率增加。评估极低出生体重（VLBW）新生儿长期经验性抗生素治疗的危险因素和结果。对 2011 年 7 月至 2012 年 6 月入住 NICU 并存活 > 2 周的 VLBW 新生儿进行的前瞻性研究。记录并比较了所有相关的围产期和产后数据，包括抗生素治疗持续时间（I 组 < 2W 与 II 组 > 2W）以及直至出院或死亡时的结果。该研究纳入了 145 名新生儿，其中 62 名属于第一组，83 名属于第二组。抗生素治疗的平均持续时间为 14 天（范围 3 - 62 天）；第一组和第二组的持续时间分别为 10 ± 2.3 天和 25.5 ± 10.5 天。住院时间分别为 22.3 ± 11.5 天和 44.3 ± 14.7 天。多元回归分析显示，以下危险因素对于长期经验性抗生素治疗具有重要意义：VLBW，特别是< 1000 g（P < 0.001）、孕产妇疾病（P = 0.003）、绒毛膜羊膜炎（P = 0.048）、多胎妊娠（P = 0.03）、无创通气（P < 0.001）和机械通气（P < 0.001）。 70 名 (48.3%) 婴儿出现 LOS； 5 名 NEC > II 期新生儿死亡，12 名（8.3%）。与 I 组相比，II 组单独和 LOS/NEC 的婴儿死亡率较高（分别 P < 0.002 和 < 0.001）。长期经验性抗生素治疗导致 LOS、NEC、HC 和婴儿死亡率增加。
Prolonged empiric antibiotics therapy in neonates results in several adverse consequences including widespread antibiotic resistance, late onset sepsis (LOS), necrotizing enterocolitis (NEC), prolonged hospital course (HC) and increase in mortality rates. To assess the risk factors and the outcome of prolonged empiric antibiotic therapy in very low birth weight (VLBW) newborns. Prospective study in VLBW neonates admitted to NICU and survived > 2 W, from July 2011 - June 2012. All relevant perinatal and postnatal data including duration of antibiotics therapy (Group I < 2W vs Group II > 2W) and outcome up to the time of discharge or death were documented and compared. Out of 145 newborns included in the study, 62 were in group I, and 83 in Group II. Average duration of antibiotic therapy was 14 days (range 3 - 62 days); duration in Group I and Group II was 10 ± 2.3 vs 25.5 ± 10.5 days. Hospital stay was 22.3 ± 11.5 vs 44.3 ± 14.7 days, respectively. Multiple regression analysis revealed following risk factors as significant for prolonged empiric antibiotic therapy: VLBW especially < 1000 g, (P < 0.001), maternal Illness (P = 0.003), chorioamnionitis (P = 0.048), multiple pregnancy (P = 0.03), non-invasive ventilation (P < 0.001) and mechanical ventilation (P < 0.001). Seventy (48.3%) infants developed LOS; 5 with NEC > stage II, 12 (8.3%) newborns died. Infant mortality alone and with LOS/NEC was higher in group II as compared to group I (P < 0.002 and < 0.001 respectively). Prolonged empiric antibiotic therapy caused increasing rates of LOS, NEC, HC and infant mortality.