极低出生体重儿院内获得性败血症围生因素分析  

Perinatal risk factors of nosocomial neonatal sepsis in very low birth weight(VLBW) infants

作　　者：丁艳[1] 施婴婴[1] 沈月华[1] 

机构地区：[1]上海交通大学附属国际和平妇幼保健院围产科,上海200030

出　　处：《中国实用儿科杂志》2009年第12期926-929,共4页Chinese Journal of Practical Pediatrics

摘　　要：目的探讨极低体重儿(VLBW)院内获得性败血症的发病情况和围生期高危因素。方法对2005年1月至2008年6月上海交通大学附属国际和平妇幼保健院发生院内获得性败血症的29例VLBW和108例非败血症的VLBW的母婴状况进行回顾性调查,采用SPSS软件进行检验和Logistic回归分析。结果137例VLBW中,有29例发生了院内获得性败血症,发生率为21.16%,死亡4例,病死率13.79%。随胎龄和出生体重降低,院内获得性败血症发生率增加。70%是革兰阴性菌感染,主要为产超广谱β内酰胺酶(ESBLs)的肺炎克雷伯菌和大肠埃希菌。出生体重≤1000g是院内获得性败血症的最重要危险因素,发生率为75%,相对危险度7.56(4.35～14.24)。增加VLBW发病的危险因素依次为体重≤1000g、中心静脉骨管(PICC)、生后2周内的贫血、新生儿坏死性小肠结肠炎、反复呼吸暂停。结论院内获得性败血症多见于VLBW,是导致VLBW晚期死亡的主要原因,必须采取各项综合措施降低院内获得性败血症的发生。Objective To explore the perinatal risk factors and clinical features of nosocomial neonatal sepsis in very-low-birth-weight（VLBW ）infants. Methods Twenty-nine VLBW infants with nosoeomial sepsis and 108 VLBW infants with non-sepsis born in hospital from January 2005 to June 2008 composed the study population. Their maternal, perinatal, or postnatal variables were retrospectively analyzed. SPSSI 1.0 software was used to do statistical tests and multiple logistic regression. Results Among 137 VLBW infants , twenty-nine were nosocomial neonatal sepsis （21.16% , 29/137）. The mortality rate was 13.79% （4/29）, The incidence of nosocomial sepsis was increased with the gestational age and birth weight decreased. Gram-negative bacteria accounted for 70% of microbes, Klebsiella pneumoniae and Escherichia colt were the most common bacterial pathogen causing nosocomial infection, mainly extended spectrum betalactamase producing euterobacteriaceae （ESBLs）. Birth weight ≤ 1000g was the most impotant risk predictor of nosocomial neonatal sepsis, incidence of NBSIs was 75% （6/8）, OR 7.56 （4.35 - 14.24）. The risk factors were in the order of percutaneously inserted central catheter （PICC） , anaemia, necrotizing enterocolitis （NEC） and apnea . Conclusion Nosocomial neonatal sepsis is a common problem and the main cause of late-onset death among very-low- birth-weight （VLBW） infants. This nosocomial infection should be lowered by active management.

关 键 词：医院内感染 极低体重儿 败血症 

分 类 号：R72[医药卫生—儿科]