新生儿水痘33例临床特征分析  

Analysis of clinical features of varicella in 33 neonates

作　　者：张艳兰 徐琳 赵扬 王彩英 庞琳 Zhang Yanlan;Xu Lin;Zhao Yang;Wang Caiying;Pang Lin(Department of Pediatrics,Beijing Ditan Hospital Affiliated to Capital Medical University,Beijing 100015,China)

机构地区：[1]首都医科大学附属北京地坛医院儿科,北京100015

出　　处：《中华新生儿科杂志（中英文）》2022年第5期409-412,共4页Chinese Journal of Neonatology

基　　金：首都医科大学附属北京地坛医院院内科研基金“桥梁计划”项目(DTQL202102)。

摘　　要：目的探讨新生儿水痘的临床特点、诊断、并发症及预后。方法选择2008年9月至2019年12月在北京地坛医院儿科住院的新生儿水痘患儿为研究对象,回顾性分析新生儿水痘的临床特点、诊断、并发症及预后。结果共收治新生儿水痘33例,男18例,女15例,足月儿32例,早产儿1例。胎龄(38.8±1.2)周,出生体重(3670±247)g,发病日龄14.0(8.0,19.0)d,确诊日龄18.0(11.5,23.0)d,住院时间(8.1±3.7)d(2~20 d)。母亲均否认既往患水痘或水痘疫苗接种史。33例患儿中有水痘/带状疱疹接触史29例。33例患儿均有典型皮疹,25例伴发热。诊断先天性水痘13例,获得性水痘20例;合并心肌酶异常24例,皮肤感染11例,贫血9例,肝损害8例,粒细胞减少/缺乏6例,肺炎、败血症各4例,病毒性脑炎1例。予静脉阿昔洛韦抗病毒治疗20例,抗生素治疗17例,应用丙种球蛋白15例,抗病毒及丙种球蛋白联合治疗8例,使用重组人粒细胞刺激因子6例。治愈出院31例,2例皮疹好转后自动出院,经电话随访均痊愈。结论新生儿水痘患儿多有明确接触史,除皮疹外可合并心肌酶异常、肝损害、粒细胞减少/缺乏、肺炎、病毒性脑炎等并发症,静脉应用阿昔洛韦、丙种球蛋白、对症支持等综合治疗,多预后良好。Objective To study the clinical characteristics,diagnosis,complications and prognosis of neonatal varicella.Methods From September 2008 to December 2019,the clinical data of hospitalized neonates with varicella in our hospital were retrospectively analyzed.Results A total of 33 cases of neonatal varicella were reviewed,including 18 males and 15 females,32 full-term infants and 1 premature infant.The gestational age(GA)was(38.8±1.2)w and birth weight(BW)was(3670±247)g.The onset of the disease occurred at 14.0(8.0,19.0)d and was diagnosed at 18.0(11.5,23.0)d.The hospital stay duration was(8.1±3.7)(2~20)d.All mothers denied varicella history or varicella vaccination.Among the 33 infants,29 had a history of varicella/zoster exposure.All 33 infants had typical rash and 25 had fever,body temperature(38.3±0.6)℃and duration(2.4±1.4)d.13 cases were congenital varicella,20 cases were acquired varicella.24 cases abnormality of cardiac enzymes,11 cases skin infection,8 cases liver damage,4 cases pneumonia,6 cases granulocytopenia/agranulocytosis,9 cases anemia,4 cases sepsis and 1 case viral encephalitis were diagnosed.20 infants received intravenous antiviral therapy(acyclovir),17 were treated with antibiotics,15 were given intravenous immunoglobulin(IVIG),8 received both antiviral therapy and IVIG and 6 were treated with recombinant human granulocyte stimulating factor.31 infants were cured and discharged.2 infants were discharged after improvement of rashes.All infants reported complete recovery on telephone follow-up.Conclusions Most neonatal varicella cases have a definite exposure history.Besides rashes,complications including pneumonia,liver damage,myocardial injury,granulocytopenia/agranulocytosis,viral encephalitis are common.Intravenous antiviral therapy with acyclovir and combined treatment of IVIG and symptomatic support can often achieve a good prognosis.

关 键 词：水痘-带状疱疹病毒 婴儿 新生 临床特点 治疗 预后 

分 类 号：R722.1[医药卫生—儿科]