新生儿李斯特菌败血症临床诊治分析  

Retrospective study of listeriosis in newborn

作　　者：沈艳华[1] 刘红[1] 齐宇洁[1] 董世霄[1] 李耿[1] 刘靖媛[1] 翁景文[1] 

机构地区：[1]北京儿童医院新生儿中心,100045

出　　处：《中国新生儿科杂志》2014年第2期82-85,共4页Chinese Journal of Neonatology

摘　　要：目的探讨新生儿李斯特菌败血症的临床特点及诊治。方法回顾性分析2008年1月至2013年6月于我院新生儿重症监护病房收治、血培养阳性的产单核细胞增生性李斯特菌败血症新生儿,记录母亲孕产史,患儿围产期情况、临床表现、实验室检查、治疗经过及预后等,结合相关文献对新生儿产单核细胞增生性李斯特菌败血症临床特点进行探讨。结果共收治10例新生儿李斯特菌败血症患儿,男8例,女2例;早产儿3例;48h内发病8例,>7天发病2例;母亲围产期发热6例;羊水异常10例。临床表现:10例均反应差,呼吸异常7例,发热5例,惊厥2例,休克1例。实验室检查:血WBC升高(>19.5×109/L)6例,降低2例(<5×109/L),正常2例。白细胞分类单核细胞百分比升高10例;CPR升高10例。血培养产单核细胞增生性李斯特菌10例,合并化脓性脑膜炎3例。治疗:美罗培南8例,青霉素加头孢类抗生素2例;转归:治愈7例,好转1例,自动出院后死亡2例。结论新生儿李斯特菌败血症病情凶险,病死率高,对于有高危因素的新生儿应作为重点监护对象,血常规中白细胞分类单核细胞百分比>8%、脑脊液常规白细胞以单核细胞为主者,应高度怀疑单核细胞增生性李斯特菌败血症,做到早发现、早治疗。Objective To newborn rerospectively. Methods study and discuss the diagnosis and treatment of Listeria sepsis in the Retrospectively analyzed 10 cases of listeriosis in the newborn admitted in neonatal intensive care unit of the Hospital from January 2008 to June 2013. The diagnosis of Listerosis was confirmed by blood euhure. Data collected included maternal history, perinatal events, clinical features, laboratory findings; treatment and prognosis. Literatures on listeria infection are reviewed. Results Among 10 cases in this study, eight males, two females, three of them are preterm infants. Eight of them had symptoms within 48 hours after birth, two of them after 7 days of life. Six of them had history of maternal fever. All of them with stained amniotic fluid or foul smelling fluid. Clinical features included poor response （ 10 cases ） , respiratory difficulty （ 7 cases ） , fever （ 5 cases ） , convulsion （2 eases）, and shock （1 ease）. Laboratory findings showed raised white blood cell count （ 〉 19.5× 109/L, 6 eases）, decreased （ 〈5 x 109/L, 2 eases）, and within normal range 2 cases. All of them had an elevated mononuclear cell count. CRP was elevated in 10 eases with positive blood cultures positive. Three of them also had purulent meningitis. Antibiotics treatment included meropenem （8 cases）, penicillin combined with cephalosporins （2 eases）. Seven of them improved, one improved, two died after withdraw of treatment. Conclusions Neonatal listeria sepsis is serious clinical condition with high mortality. Physicians should mindful of this potentially fatal condition especially in the presence of elevated mononuclear cell count together with other clinic appearance in neonates, and appropriate treatment given promptly.

关 键 词：李斯特菌病 败血症 婴儿 新生 

分 类 号：R722.131[医药卫生—儿科]