Arnon Shmuel, Litmanovitz Ita, Regev Rivka, Lis Monica, Shainkin-Kestenbaum Ruth, Dolfin Tzipora
Department of Neonatology, Meir Hospital, Sapir Medical Center, Kfar-Saba, Israel.
J Perinat Med. 2004;32(2):176-80. doi: 10.1515/JPM.2004.032.
Late-onset sepsis (occurring after the first three days of life) is a serious complication in preterm infants. In order to assess the possible prognostic virtues of the acute phase inflammatory response in the disease, we compared the inflammatory response of preterm infants who died within 72 hours (h) (fulminant sepsis) to infants who recovered from the disease (non-fulminant sepsis).
Of 42 preterm infants that were evaluated: 10 had fulminant sepsis and 32 non-fulminant sepsis. Acute phase inflammatory response markers-C-reactive protein (CRP), serum amyloid A (SAA), interleukin (IL)-6 levels and white blood cell (WBC) counts were measured at the first suspicion of LOS and after 8, 24 and 48 h.
Small for gestational age (SGA) infants who were treated with fewer days of antibiotics characterized the fulminant sepsis group. The initial high levels of inflammatory markers were similar in both groups, but as early as 8 h after onset significantly lower levels of SAA, CRP and WBC counts were documented in the fulminant sepsis group. The inflammatory response remained low at 24 and 48 h in the fulminant sepsis group, while in the survivors, significantly increased inflammatory markers were measured. Decreases in the levels of the inflammatory markers preceded episodes of metabolic acidosis and arterial hypotension that were more common in the fulminant sepsis group. Infant mortality correlated inversely with SAA levels at 8 h and with CRP and WBC counts at 24 h after onset.
SAA, CRP and WBC counts can be used as prognostic markers in LOS in preterm infants, with SAA being the earliest prognostic marker.
迟发性败血症（发生在出生后三天之后）是早产儿的一种严重并发症。为了评估急性期炎症反应在该疾病中可能的预后价值，我们比较了在72小时内死亡的早产儿（暴发性败血症）与从该疾病中康复的婴儿（非暴发性败血症）的炎症反应。
在评估的42例早产儿中，10例患有暴发性败血症，32例患有非暴发性败血症。在首次怀疑发生迟发性败血症时以及8、24和48小时后，测量急性期炎症反应标志物——C反应蛋白（CRP）、血清淀粉样蛋白A（SAA）、白细胞介素（IL）-6水平和白细胞（WBC）计数。
暴发性败血症组的特点是小于胎龄（SGA）婴儿接受抗生素治疗的天数较少。两组炎症标志物的初始高水平相似，但早在发病后8小时，暴发性败血症组的SAA、CRP和WBC计数水平就显著降低。暴发性败血症组在24和48小时时炎症反应仍较低，而在幸存者中，炎症标志物显著升高。炎症标志物水平的下降先于代谢性酸中毒和动脉低血压发作，这些在暴发性败血症组中更常见。婴儿死亡率与发病后8小时的SAA水平以及24小时的CRP和WBC计数呈负相关。
SAA、CRP和WBC计数可作为早产儿迟发性败血症的预后标志物，其中SAA是最早的预后标志物。
