快速识别严重细菌感染低风险的发热新生儿：一项观察性研究。

Quick identification of febrile neonates with low risk for serious bacterial infection: an observational study.

作者信息

Marom R, Sakran W, Antonelli J, Horovitz Y, Zarfin Y, Koren A, Miron D

机构信息

Rappaport School of Medicine, Haifa, Israel.

出版信息

Arch Dis Child Fetal Neonatal Ed. 2007 Jan;92(1):F15-8. doi: 10.1136/adc.2005.087981.

DOI:10.1136/adc.2005.087981

PMID:17185424

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC2675288/

Abstract

OBJECTIVE

To examine the possible usefulness of simple and quick criteria for identifying febrile neonates with low risk for serious bacterial infection (SBI).

DESIGN

All febrile neonates who were admitted between August 1998 and August 2003 to the Pediatric Emergency Department, HaEmek Medical Center, Afula, Israel, and to the Poriya Hospital, Tiberias, Israel, were included in the study. The recommended evaluation of each neonate included details of medical history and a complete physical examination, including blood culture, erythrocyte sedimentation rate (ESR), white cell count (WBC), and analysis and culture of urine and cerebrospinal fluid. Other tests were carried out as necessary. Patients who met all the following criteria were considered to have low risk for SBI: (1) unremarkable medical history; (2) good appearance; (3) no focal physical signs of infection; (4) ESR <30 mm at the end of the first hour; (5) WBC 5000-15 000/mm(3); (6) a normal urine analysis by the dipstick method.

RESULTS

Complete data were available for 386 neonates. SBI was documented in 108 (28%) neonates, of whom 14% had a urinary tract infection, 9.3% had acute otitis media, 2.3% had pneumonia, 1.3% had cellulitis, 0.5% had bacterial meningitis and 0.5% had bacterial gastroenteritis. The overall incidence of SBI was 1 in 166 (0.6%) neonates who fulfilled the criteria compared with 107 in 220 (48.6%) in the neonates who did not fulfil the criteria (p<0.001). The negative predictive value for SBI of the combination of the low-risk criteria was 99.4% (95% confidence interval 99.35% to 99.45%).

CONCLUSIONS

Fulfillment of the criteria for low risk might be a reliable and useful tool for excluding SBI in febrile neonates.

摘要

目的

探讨用于识别严重细菌感染（SBI）低风险发热新生儿的简单快速标准的可能实用性。

设计

纳入1998年8月至2003年8月间入住以色列阿富拉海梅克医疗中心儿科急诊科以及以色列提比里亚斯波里亚医院的所有发热新生儿。对每名新生儿的推荐评估包括病史细节及全面体格检查，包括血培养、红细胞沉降率（ESR）、白细胞计数（WBC）以及尿液和脑脊液分析及培养。必要时进行其他检查。符合以下所有标准的患者被认为SBI风险低：（1）病史无异常；（2）外观良好；（3）无感染的局灶性体征；（4）第一小时末ESR<30mm；（5）WBC 5000 - 15000/mm³；（6）试条法尿液分析正常。

结果

386例新生儿有完整数据。108例（28%）新生儿记录有SBI，其中14%患有尿路感染，9.3%患有急性中耳炎，2.3%患有肺炎，1.3%患有蜂窝织炎，0.5%患有细菌性脑膜炎，0.5%患有细菌性胃肠炎。符合标准的新生儿中SBI总体发生率为166例中的1例（0.6%），而不符合标准的220例新生儿中有107例（48.6%）（p<0.001）。低风险标准组合对SBI的阴性预测值为99.4%（95%置信区间99.35%至99.45%）。