Division of Neonatal-Perinatal Medicine, Department of Pediatrics, University of Texas Southwestern Medical School, Dallas, TX.
Department of Health Systems Research, Parkland Health & Hospital System, Dallas, TX.
J Pediatr. 2014 Mar;164(3):522-8.e1-3. doi: 10.1016/j.jpeds.2013.10.080. Epub 2013 Dec 10.
To validate established neonatal neutrophil reference ranges (RRs) and determine the utility of serial measurements of neutrophil values in the first 24 hours to predict the absence of neonatal early-onset sepsis (EOS).
Retrospective study of 2073 admissions to the neonatal intensive care unit (2009-2011). Neonates were classified as blood culture-positive, proven EOS (n = 9), blood culture-negative but clinically suspect EOS (n = 292), and not infected (n = 1292). Neutrophil values from 745 not-infected neonates without perinatal complications were selected to validate RR distributions. Positive and negative predictive values were calculated; area under receiver operating characteristic curves (AUCs) were constructed to predict the presence or absence of EOS. Neutrophil value scores were established to determine whether serial neutrophil values predict the absence of EOS.
Seventy-seven percent of admissions to the neonatal intensive care unit were evaluated for EOS: 9 (0.56%) had proven EOS with positive blood culture ≤ 37 hours; 18% had clinically suspect EOS. Neutropenia occurred in preterm neonates, and nonspecific neutrophilia was common in uninfected neonates. The distribution of neutrophil values differed significantly between study groups. The specificity for absolute total immature neutrophils and immature to total neutrophil proportions was 91% and 94%, respectively, with negative predictive value of 99% for proven and 78% for proven plus suspect EOS. Absolute total immature neutrophils and immature to total neutrophil proportions had the best predictability for EOS >6 hours postnatal with an AUC ∼ 0.8. Neutrophil value scores predicted the absence of EOS with AUC of 0.9 and 0.81 for proven and proven plus suspect EOS, respectively.
Age-dependent neutrophil RRs remain valid. Serial neutrophil values at 0, 12, and 24 hours plus blood culture and clinical evaluation can be used to discontinue antimicrobial therapy at 36-48 hours.
验证已建立的新生儿中性粒细胞参考范围（RR），并确定在最初 24 小时内连续测量中性粒细胞值以预测新生儿早发性败血症（EOS）的有无。
对新生儿重症监护病房（2009-2011 年）的 2073 例入院病例进行回顾性研究。将新生儿分为血培养阳性、确诊 EOS（n=9）、血培养阴性但临床疑似 EOS（n=292）和未感染（n=1292）。选择无围产期并发症的 745 例未感染新生儿的中性粒细胞值来验证 RR 分布。计算阳性和阴性预测值；构建受试者工作特征曲线（AUC）下面积以预测 EOS 的存在或不存在。建立中性粒细胞值评分以确定连续中性粒细胞值是否可预测 EOS 不存在。
新生儿重症监护病房 77%的入院病例评估 EOS：9 例（0.56%）血培养阳性且≤37 小时内确诊 EOS；18%为临床疑似 EOS。早产儿中性粒细胞减少症，未感染新生儿非特异性中性粒细胞增多症常见。研究组之间中性粒细胞值的分布差异有统计学意义。绝对总未成熟中性粒细胞和未成熟与总中性粒细胞比例的特异性分别为 91%和 94%，对确诊和确诊加疑似 EOS 的阴性预测值分别为 99%和 78%。绝对总未成熟中性粒细胞和未成熟与总中性粒细胞比例在出生后 6 小时以上对 EOS 的预测能力最佳，AUC 约为 0.8。中性粒细胞值评分对 EOS 的预测 AUC 为 0.9 和 0.81，分别用于确诊和确诊加疑似 EOS。
年龄依赖性中性粒细胞 RR 仍然有效。0、12 和 24 小时的连续中性粒细胞值加上血培养和临床评估可用于在 36-48 小时时停止抗菌治疗。
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