Wójkowska-Mach Jadwiga, Helwich Ewa, Borszewska-Kornacka Maria, Gadzinowski Janusz, Gulczyńska Ewa, Kordek Agnieszka, Pawlik Dorota, Szczapa Jerzy, Domańska Joanna, Klamka Jerzy, Heczko Piotr B
Klinika Neonatologii i Intensywnej Terapii, Warszawa.
Med Wieku Rozwoj. 2013 Apr-Jun;17(2):143-50.
To determine the risk of various forms of infections appearing in very low birth weight newborns (VLBW) during the period of 30 days after surgical treatment in hospitals which have perinatal care departments with neonatal intensive care units that form the Polish Neonatology Surveillance Network (PNSN).
Continuous prospective monitoring of infections was carried out from January 1st to December 31st 2009 in six neonatal intensive care units which form the Polish Neonatal Surveillance Network. (PNSN). 910 newborns with very low birth weight (VLBW) were included in the study programme. 91 (10%) of this group underwent 118 surgical interventions. 12 newborns needed two or more surgeries. The most common procedure was the closure of persistent ductus artesiosus (PDA) and photocoagulation of vascular damage in the eye fundus.
In the period of 30 days after surgery the following were diagnosed: in 3 newborns - necrotizing enterocolitis (NEC), in 22 newborns - sepsis (BSI) and in 54 newborns - pneumonia (PNEU). Symptoms of BSI and PNEU were on average observed on the 10th day after surgical intervention, while in the case of NEC on the 17th day. The highest incidence of infection (148.4%) was observed after PDA closure and in connection with introducing a drain into the pleural cavity through the intercostal space. The incidence of PN EU (37.3%) was twice as high as the incidence of BSI (18.6%). Surgical procedure was a factor significantly increasing the risk of infection and morbidity (RR 2.1, P<001) In our investigations there was no case of the local infection of a surgical site. 11 newborns died (mortality was 12.1%). The most common bacterial strains found in our investigation were coagulase-negative Staphylococcus and Escherichia Coli.
Taking into consideration the fact that surgical procedure in VLBW-newborns significantly increases the risk of pneumonia and to a minor degree the risk of NEC and BSI, further detailed investigation in the field of perisurgical epidemiology is needed in order to elaborate a more deeply oriented and more effective strategy of infection prevention in the group of VLBW newborns.
确定在设有新生儿重症监护病房的围产期护理部门且这些部门构成波兰新生儿学监测网络（PNSN）的医院中，极低出生体重新生儿（VLBW）在手术治疗后30天内出现各种感染形式的风险。
2009年1月1日至12月31日，对构成波兰新生儿监测网络（PNSN）的六个新生儿重症监护病房进行了感染的连续前瞻性监测。910例极低出生体重（VLBW）新生儿被纳入研究计划。该组中有91例（10%）接受了118次手术干预。12例新生儿需要进行两次或更多次手术。最常见的手术是动脉导管未闭（PDA）结扎术和眼底血管损伤的光凝术。
术后30天内诊断出：3例新生儿患有坏死性小肠结肠炎（NEC），22例新生儿患有败血症（BSI），54例新生儿患有肺炎（PNEU）。BSI和PNEU的症状平均在手术干预后第10天出现，而NEC的症状在第17天出现。PDA结扎术后以及通过肋间间隙向胸腔置入引流管后观察到最高的感染发生率（148.4%）。PNEU的发生率（37.3%）是BSI发生率（18.6%）的两倍。手术操作是显著增加感染和发病风险的一个因素（相对危险度2.1，P<0.01）。在我们的调查中没有手术部位局部感染的病例。11例新生儿死亡（死亡率为12.1%）。我们调查中发现的最常见细菌菌株是凝固酶阴性葡萄球菌和大肠杆菌。
考虑到极低出生体重新生儿的手术操作会显著增加肺炎风险，并在较小程度上增加NEC和BSI风险，需要在围手术期流行病学领域进行进一步详细研究，以便为极低出生体重新生儿群体制定更具针对性和更有效的感染预防策略。
