美国 1988-2006 年新生儿和婴儿临床败血症。

Clinical sepsis in neonates and young infants, United States, 1988-2006.

机构信息

National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, MD, USA.

出版信息

J Pediatr. 2012 Jun;160(6):960-5.e1. doi: 10.1016/j.jpeds.2011.12.023. Epub 2012 Jan 18.

DOI:10.1016/j.jpeds.2011.12.023

PMID:22261508

Abstract

OBJECTIVE

To describe the burden and characteristics of clinical neonatal sepsis in the United States and evaluate incidence rates after the issuance of intrapartum antibiotic prophylaxis (IAP) guidelines.

STUDY DESIGN

This is a cross-sectional study of hospitalizations of infants aged <3 months diagnosed with sepsis from the 1988-2006 National Hospital Discharge Survey. The National Hospital Discharge Survey collects data annually on inpatient discharges from a national probability sample of approximately 500 short-stay hospitals. We examined sepsis hospitalizations, defined by International Classification of Diseases, Ninth Revision, Clinical Modification codes, and compared sepsis hospitalization rates for 2 time periods after the issuance of IAP guidelines (1996-2001 and 2002-2006) with 1988-1995 using national natality data as the population denominator. We used Joinpoint (Surveillance Research Program, National Cancer Institute, Bethesda, Maryland) regression to assess the average annual percent change (AAPC) in rates.

RESULTS

Between 1988 and 2006, there were more than 2.5 million sepsis-related hospitalizations in infants aged <3 months (112 000-146 000 annually). In 2006, the sepsis hospitalization rate was 30.8/1000 births. The rate was more than 3 times higher in preterm infants compared with term infants (85.4/1000 preterm births vs 23.1/1000 term births). The AAPC in sepsis hospitalization rate was -3.6% (95% CI, -5.1% to 2.0%) [corrected] for term infants during 1996-2002 and did not change significantly after issuance of the revised 2002 guidelines. For preterm infants, the AAPC was -1.2% (95% CI, -2.2% to -0.1%) [corrected] annually from 1988 to 2006.

CONCLUSION

Clinical neonatal sepsis declined in the post-IAP era, mirroring trends observed in group B streptococcal early-onset neonatal sepsis surveillance. Preterm infants were affected disproportionately and exhibited a modest but steady decline in sepsis hospitalization rate.

摘要

目的

描述美国新生儿临床败血症的负担和特征，并评估在发布产时抗生素预防（IAP）指南后发病率的变化。

研究设计

这是一项 1988-2006 年全国医院出院调查中年龄<3 个月的婴儿因败血症住院的横断面研究。全国医院出院调查每年从约 500 家短期住院医院的全国概率样本中收集住院患者的数据。我们检查了败血症住院情况，根据国际疾病分类，第九版，临床修正码进行定义，并将 IAP 指南发布后的 2 个时间段（1996-2001 年和 2002-2006 年）与 1988-1995 年的败血症住院率进行比较，以全国出生率数据作为人口分母。我们使用 Joinpoint（监测研究计划，国家癌症研究所，马里兰州贝塞斯达）回归评估率的平均年百分变化（AAPC）。

结果

在 1988 年至 2006 年期间，有超过 250 万例与败血症相关的婴儿<3 个月（每年 112000-146000 例）住院治疗。2006 年，败血症住院率为 30.8/1000 例出生。早产儿的发病率比足月儿高 3 倍以上（85.4/1000 例早产儿与 23.1/1000 例足月儿）。在 1996-2002 年期间，足月婴儿的败血症住院率 AAPC 为-3.6%（95%可信区间，-5.1%至 2.0%）[校正]，在发布修订后的 2002 年指南后没有显著变化。对于早产儿，从 1988 年至 2006 年，AAPC 为每年-1.2%（95%可信区间，-2.2%至-0.1%）[校正]。