Zuppa A A, Calabrese V, D'Andrea V, Fracchiolla A, Scorrano A, Orchi C, Romagnoli C
Divisione di Neonatologia, Dipartimento di Pediatria, Università Cattolica del Sacro Cuore, Roma, Italy.
Minerva Pediatr. 2007 Jun;59(3):267-74.
Neonatal sepsis occurs from 1 to 21 newborns out of 1 000 live births with mortality rates as high as 30% up to 69%. The most important risk factors are prematurity, low birth weight, invasive medical procedure and prolonged hospitalization in neonatal intensive care units. An aimed and restrictive antibiotic therapy has an outstanding importance to reduce both morbidity-mortality rates and multiple drug-resistance. Generally, preterm newborns present nonspecific clinical signs of infection. The use of high sensitivity infection markers and a negative predictive value (near 100%) are important to distinguish infected and noninfected patients before the culture results and to verify adequacy and duration of antibiotic therapy. This article reviews the immunologic function and practical use of C reactive protein (CRP) and other markers in the diagnosis of neonatal sepsis. While CRP is a specific late infection marker, cytokines, cell surface markers and procalcitonin (PCT) are early infection markers. The use of multiple markers as CRP, PCT, IL-6, IL-8, CD64, CD11b is useful both to early (24-48 h) diagnose of neonatal sepsis, and to monitorate the antibiotic treatment while waiting for the results of cultural examinations.
每1000例活产新生儿中，有1至21例会发生新生儿败血症，死亡率高达30%至69%。最重要的危险因素是早产、低出生体重、侵入性医疗操作以及在新生儿重症监护病房的长时间住院。有针对性的限制性抗生素治疗对于降低发病率、死亡率以及多重耐药性具有极其重要的意义。一般来说，早产新生儿会出现非特异性感染临床症状。在培养结果出来之前，使用高灵敏度感染标志物以及阴性预测值（接近100%）对于区分感染和未感染患者以及核实抗生素治疗的充分性和持续时间很重要。本文综述了C反应蛋白（CRP）和其他标志物在新生儿败血症诊断中的免疫功能及实际应用。虽然CRP是一种特异性的晚期感染标志物，但细胞因子、细胞表面标志物和降钙素原（PCT）是早期感染标志物。联合使用多种标志物如CRP、PCT、白细胞介素-6（IL-6）、白细胞介素-8（IL-8）、CD64、CD11b，对于早期（24至48小时）诊断新生儿败血症以及在等待培养检查结果期间监测抗生素治疗都很有用。
