小于90天婴儿不明原因发热的诊治进展  

Advances in diagnosis and treatment of fever of unknown origin in infants younger than 90 days of age

作　　者：张则玮 赵桂增[1] 高荧 ZHANG Zewei;ZHAO Guizeng;GAO Ying(Department of Pediatrics,First People’s Hospital of Tancheng,Shandong Province,Tancheng 276199,China;Department of Pharmacy,First People’s Hospital of Tancheng,Shandong Province,Tancheng 276199,China)

机构地区：[1]山东省郯城县第一人民医院儿科,山东郯城276199 [2]山东省郯城县第一人民医院药学部,山东郯城276199

出　　处：《妇儿健康导刊》2024年第22期21-25,共5页JOURNAL OF WOMEN AND CHILDREN'S HEALTH GUIDE

摘　　要：小于90日龄婴儿不明原因发热是儿科临床常见问题,需尽快识别是自限性病毒感染还是严重细菌感染,以避免严重后果。在美国儿科学会和加拿大儿科学会近年发布的健康外观8~60日龄和小于90日龄婴儿不明原因发热管理指南中,提出根据日龄、尿液分析、炎症标志物检测结果进行风险分层。各日龄组婴儿都需要进行尿液分析、尿液培养、血液培养,以及外周血中性粒细胞绝对值、C反应蛋白和降钙素原等炎症标志物检查。小于22或29日龄的新生儿以及炎症标志物异常的高风险婴儿做腰椎穿刺查脑脊液、住院并注射用抗菌药物治疗,而炎症标志物正常的低风险婴儿不必进行脑脊液检查,部分甚至不用抗菌药物,居家治疗即可。单纯尿路感染婴儿可以口服抗菌药物治疗。Fever of unknown origin in infants younger than 90 days old is a common clinical problem in pediatrics and it is important to identify a self-limiting viral infection or a serious bacterial infection as soon as possible to avoid serious consequences.In the guidelines on the management of fever of unknown origin in healthy-looking eight to 60-day-old and<90-day-old infants published in recent years by the American Academy of Pediatrics and the Canadian Pediatric Society,risk stratification based on age,urine analysis,and inflammatory markers(IMs)test results is proposed.Urinalysis,urine culture,blood culture,and IMs such as absolute peripheral blood neutrophil count,C-reactive protein,and procalcitonin are required for infants in all day-age groups.Infants younger than 22 or 29 days old and high-risk infants with abnormal IMs were treated with lumbar puncture for cerebrospinal fluid(CSF)examination,hospitalization,and parenteral antibiotics,while low-risk infants with normal IMs do not need CSF examination and some may even be treated at home without antibiotics.Infants with simple urinary tract infections can be treated with oral antibiotics.

关 键 词：婴儿 不明原因发热 严重细菌感染 侵袭性细菌感染 风险分层 

分 类 号：R722.13[医药卫生—儿科]