极低出生体重儿晚发型脓毒症发生概况及其不良预后的多中心前瞻性队列研究  

A multicenter prospective cohort study of late-onset sepsis and its poor prognosis in very low birth weight infants

作　　者：多中心极低出生体重儿预后评估协作组 于永慧 张丙金[3] Multicenter Study Collaborative Group for Evaluation of Outcomes in Very Low Birth Weight Infants;Yu Yonghui;Zhang Bingjin(不详;Department of Neonatology,Shandong Provincial Hospital Afiliated to Shandong First Medical University,Jinan 250021,China;Department of Neonatology,Dongying Shengli Oifield Central Hospital,Dongying 257000,China)

机构地区：[1]不详 [2]山东第一医科大学附属省立医院新生儿科,济南250021 [3]东营胜利油田中心医院新生儿科,东营257000

出　　处：《中华儿科杂志》2023年第3期228-234,共7页Chinese Journal of Pediatrics

摘　　要：目的探讨极低出生体重儿(VLBWI)晚发型脓毒症(LOS)的发生概况及其不良预后。方法采用多中心前瞻性观察性队列研究,数据来源于中国北方新生儿协作网(SNN),收集并分析2018至2021年35家新生儿重症监护病房收治的6639例VLBWI的一般资料、围生期情况及不良预后发生情况。根据住院期间是否发生LOS,分为LOS组和无LOS组,LOS组根据是否合并新生儿坏死性小肠结肠炎(NEC)及化脓性脑膜炎分为3个亚组。采用χ^(2)检验或Fisher确切概率法、独立样本t检验、Mann-Whitney U检验及多因素Logistic回归模型,分析LOS与不良预后的关系。结果6639例VLBWI中男3402例(51.2%),发生LOS 1511例(22.8%),其中超低出生体重儿(ELBWI)及超早产儿LOS的发生率分别为33.3%(392/1176)和34.2%(378/1105);LOS组死亡157例(10.4%),其中LOS并发NEC组死亡48例(24.9%)。多因素Logistic回归分析显示,LOS并发NEC组与病死率和3~4级脑室内出血(IVH)或脑室周围白质软化(PVL)、中重度支气管肺发育不良(BPD)、宫外生长发育迟缓(EUGR)发生率的增加均相关(OR=5.27、2.59、3.04、2.04,95%CI 3.60~7.73、1.49~4.50、2.11~4.37、1.50~2.79,均P<0.01);LOS并发化脓性脑膜炎组与病死率和3~4级IVH或PVL、中重度BPD发生率的增加均相关(OR=2.22、8.13、3.69,95%CI 1.30~3.77、5.22~12.67、2.49~5.48,均P<0.01),而LOS不并发NEC或化脓性脑膜炎组仅与中重度BPD发生率的增加相关(OR=2.20,95%CI 1.83~2.65,P<0.001)。排除污染菌后,血培养阳性共456例,其中革兰阴性菌265例(58.1%),革兰阳性菌126例(27.6%),真菌65例(14.3%);最常见的致病菌为肺炎克雷伯菌147例(32.2%),其次为凝固酶阴性葡萄球菌72例(15.8%),再次为大肠埃希菌39例(8.6%)。结论VLBWI的LOS的发生率较高,常见致病菌依次为肺炎克雷伯菌、凝固酶阴性葡萄球菌及大肠埃希菌;LOS与中重度BPD不良预后相关,并发NEC时预后差,病死率最高,并发化脓性脑膜炎时增加脑损伤的风险。Objective To investigate the prevalence and poor prognosis of late-onset sepsis(LOS)in very low birth weight infant(VLBWI).Methods This prospective,multicenter observational cohort study was conducted based on the data from Sina-Northern Neonatal Network(SNN).The general data,perinatal information and poor prognosis of 6639 VLBWI,who were admitted to the 35 neonatal intensive care units from 2018 to 2021,were collected and analyzed.According to the occurrence of LOS during hospitalization,the VLBWI were assigned to the LOS group and non-LOS group.The LOS group was further divided into 3 subgroups according to the occurrence of neonatal necrotizing enterocolitis(NEC)and purulent meningitis.The Chi-square test or Fisher exact probability method,independent sample t test,Mann-Whitney U test and multivariate Logistic regression model were used to analyze the relationship between LOS and poor prognosis in VLBWI.Results A total of 6639 eligible VLBWI were enrolled,including 3402 cases(51.2%)of males and 1511 cases(22.8%)with LOS.The incidences of LOS in extremely low birth weight infants(ELBWI)and extremely preterm infants were 33.3%(392/1176)and 34.2%(378/1105),respectively.There were 157 cases(10.4%)who died in the LOS group and 48 cases(24.9%)in the subgroup of LOS complicated with NEC.Multivariate Logistic regression analysis showed that LOS complicated with NEC was associated with increased mortality and incidence of gradeⅢ-Ⅳintraventricular hemorrhage(IVH)or periventricular leukomalacia(PVL),moderate or severe bronchopulmonary dysplasia(BPD),and extrauterin growth retardation(EUGR)(OR_(adjust)=5.27,2.59,3.04,2.04;95%CI 3.60-7.73,1.49-4.50,2.11-4.37,1.50-2.79;all P<0.01);LOS complicated with purulent meningitis was also associated with increased mortality and incidence of gradeⅢ-ⅣIVH or PVL,and moderate or severe BPD(OR_(adjust)=2.22,8.13,3.69,95%CI 1.30-3.37,5.22-12.67,2.49-5.48;all P<0.01);the infants without NEC or purulent meningitis in the LOS group was only associated with increased incidence of mode

关 键 词：婴儿 新生 婴儿 极低出生体重 晚发型脓毒症 预后 

分 类 号：R720.597[医药卫生—急诊医学]