感染高危儿脐血培养对新生儿早发型败血症的预测价值  

The predictive value of umbilical cord blood culture in high-risk infants with infection for early onset sepsis in neonates

作　　者：张春梅 王彤[2] 付辉[3] ZHANG Chunmei;WANG Tong;FU Hui(Department of Obstetrics,Tangshan Maternity and Child Health Care Hospital,Hebei Tangshan 063000,China;Department of Neonatology,Tangshan Maternity and Child Health Care Hospital,Hebei Tangshan 063000,China;Department of Pediatrics,Tangshan Maternity and Child Health Care Hospital,Hebei Tangshan 063000,China)

机构地区：[1]唐山市妇幼保健院产科,河北唐山063000 [2]唐山市妇幼保健院新生儿科,河北唐山063000 [3]唐山市妇幼保健院儿科,河北唐山063000

出　　处：《中国妇幼健康研究》2025年第1期1-6,共6页Chinese Journal of Woman and Child Health Research

基　　金：河北省2023年度医学科学研究课题计划(20231765)。

摘　　要：目的评估感染高危儿中脐血培养对新生儿早发型败血症(EOS)的预测价值。方法选取2021年1月至2022年12月期间,在唐山市妇幼保健院出生、孕周≥28周且母亲可疑或确诊宫内感染病史的感染高危儿为研究对象,行脐血培养(UCBC)。依据UCBC结果,分为UCBC阳性病例组和UCBC阴性病例组。收集研究对象的各项临床指标、理化检验结果及新生儿结局。使用t检验、χ^(2)检验比较UCBC阳性病例组与阴性病例组各指标差异。计算UCBC对EOS的敏感性、特异性、阳性预测值和阴性预测值。绘制受试者工作特征(ROC)曲线分析脐血培养对EOS的诊断价值。结果本研究共纳入536例感染高危儿脐血培养样本,除4例样本污染外,UCBC阳性病例组60例(11.3%),培养菌种19种,其中以大肠埃希菌最多(51.7%),UCBC阴性病例组472例(88.7%)。UCBC阳性与阴性病例组在分娩方式和新生儿转归比较有统计学差异(χ^(2)=23.514和6.35,P<0.05)。532例研究对象中临床诊断早发型败血症4例(0.75%),其中UCBC阳性组1例,为肺炎克雷伯氏菌感染,UCBC阴性组3例。UCBC诊断EOS的敏感性为25.0%、特异性为88.8%、阳性预测值(PPV)为1.7%,阴性预测值(NPV)为99.4%、ROC曲线下面积(AUC)为0.569。EOS患儿中,UCBC阳性患儿预后最差,UCBC阴性患儿经治疗后预后均较好。结论脐血培养尚不能作为早发型败血症诊断的有效预测指标,但脐血培养阴性结果可作为早发型败血症的排除指标。脐血培养污染率高,尤以阴道分娩更为明显,临床上应严格消毒后进行采血。重点监测早产儿及极低出生体重儿的脐血培养结果。Objective To evaluate the predictive value of umbilical cord blood culture(UCBC)for early-onset neonatal sepsis(EOS)in high-risk neonates.Methods Neonates born between January 2021 and December 2022 at Tangshan Maternal and Child Health Care Hospital with a gestational age≥28 weeks and a history of suspected or confirmed intrauterine infection in the mother were included as high-risk neonates.UCBC was performed,and based on the results,the neonates were divided into a UCBC-positive group and a UCBC-negative group.Clinical indicators,laboratory test results,and neonatal outcomes were collected.Differences between the two groups were compared using t-tests andχ^(2) tests.Sensitivity,specificity,positive predictive value(PPV),and negative predictive value(NPV)of UCBC for EOS were calculated.Receiver operating characteristic(ROC)curves were plotted to analyze the diagnostic value of UCBC for EOS.Results A total of 536 high-risk neonates UCBC samples were included in this study.After excluding 4 contaminated samples,the UCBC-positive group consisted of 60 cases(11.3%)with 19 different pathogens identified,with Escherichia coli being the most common(51.7%).The UCBC-negative group included 472 cases(88.7%).Statistically significant differences were found between the two groups regarding delivery mode and neonatal outcomes(χ^(2)=23.514 and 6.35,respectively,P<0.05).Among the 532 study participants,4 cases(0.75%)were clinically diagnosed with EOS,including 1 case in the UCBC-positive group(Klebsiella pneumoniae infection)and 3 cases in the UCBC-negative group.The sensitivity of UCBC for diagnosing EOS was 25.0%,specificity was 88.8%,PPV was 1.7%,NPV was 99.4%,and the area under the ROC curve(AUC)was 0.569.In EOS cases,those with UCBC-positive results had the worst prognosis,while UCBC-negative infants had a better prognosis after treatment.Conclusion Umbilical cord blood culture cannot be used as an effective predictive indicator for the diagnosis of early-onset sepsis.However,a negative UCBC result can be used as an

关 键 词：感染高危儿 新生儿 脐血培养 早发败血症 预测价值 

分 类 号：R174.6[医药卫生—妇幼卫生保健]