Webber S, Wilkinson A R, Lindsell D, Hope P L, Dobson S R, Isaacs D
John Radcliffe Hospital, Oxford, Neonatal Unit, Department of Paediatrics.
Arch Dis Child. 1990 Feb;65(2):207-11. doi: 10.1136/adc.65.2.207.
All babies admitted to the neonatal unit during a period of 41 months were prospectively studied to find out the incidence, aetiology, and outcome of neonatal pneumonia, and the value of routine cultures of endotracheal tubes. Pneumonia of early onset (before age 48 hours) occurred in 35 babies (incidence 1.79/1000 live births). In 20 (57%) it was caused by group B streptococci. Blood cultures showed the presence of organisms in 16 of the 35 (46%). There were 41 episodes of pneumonia of late onset in 39 babies. Thirty six of the 39 were preterm, and 34 were artificially ventilated (10% of all ventilated babies). Endotracheal tube colonisation had occurred in 94% of these, most commonly by Gram negative organisms and Staphylococcus epidermidis. In only one of seven cases with simultaneous bacteraemia was the same organism grown from cultures of the blood. After controlling for gestational age and duration of artificial ventilation there was no difference in the incidence or timing of endotracheal tube colonisation between babies who did and did not have pneumonia of late onset. Ten babies with pneumonia of early onset (29%) died; all were preterm infants. Only one death (2%) was associated with an episode of pneumonia of late onset. Routine surveillance cultures were not helpful in predicting and managing pneumonia of late onset.
对41个月期间入住新生儿病房的所有婴儿进行前瞻性研究，以了解新生儿肺炎的发病率、病因及转归，以及气管内导管常规培养的价值。早发型（48小时内）肺炎发生在35例婴儿中（发病率为1.79/1000活产）。其中20例（57%）由B族链球菌引起。血培养显示35例中有16例（46%）存在细菌。39例婴儿发生41次晚发型肺炎。39例中有36例为早产儿，34例接受人工通气（占所有通气婴儿的10%）。这些婴儿中94%发生气管内导管定植，最常见的是革兰阴性菌和表皮葡萄球菌。在7例同时发生菌血症的病例中，只有1例血培养与气管内导管培养生长出相同细菌。在控制胎龄和人工通气时间后，发生和未发生晚发型肺炎的婴儿在气管内导管定植的发生率或时间上没有差异。10例早发型肺炎婴儿（29%）死亡；均为早产儿。仅1例死亡（2%）与晚发型肺炎发作有关。常规监测培养对预测和处理晚发型肺炎没有帮助。
