Turner Claudia, Turner Paul, Hoogenboom Gabie, Aye Mya Thein Naw, McGready Rose, Phakaudom Kawalee, De Zoysa Aruni, Efstratiou Androulla, Heath Paul T, Nosten François
Shoklo Malaria Research Unit, Mae Sot 63110, Thailand.
BMC Infect Dis. 2013 Dec 21;13:601. doi: 10.1186/1471-2334-13-601.
Each year an estimated four million neonates die, the majority in the first week of life. One of the major causes of death is sepsis. Proving the incidence and aetiology of neonatal sepsis is difficult, particularly in resource poor settings where the majority of the deaths occur.
We conducted a three year observational study of clinically diagnosed early onset (<7 days of age) neonatal sepsis (EONS) in infants born to mothers following antenatal care at the Shoklo Malaria Research Unit clinic in Maela camp for displaced persons on the Thailand-Myanmar border. Episodes of EONS were identified using a clinical case definition. Conventional and molecular microbiological techniques were employed in order to determine underlying aetiology.
From April 2009 until April 2012, 187 infants had clinical signs of EONS, giving an incidence rate of 44.8 per 1000 live births (95% CI 38.7-51.5). One blood culture was positive for Escherichia coli, E. coli was detected in the cerebrospinal fluid specimen in this infant, and in an additional two infants, by PCR. Therefore, the incidence of bacteriologically proven EONS was 0.7 per 1000 live births (95% CI 0.1-2.1). No infants enrolled in study died as a direct result of EONS.
A low incidence of bacteriologically proven EONS was seen in this study, despite a high incidence of clinically diagnosed EONS. The use of molecular diagnostics and nonspecific markers of infection need to be studied in resource poor settings to improve the diagnosis of EONS and rationalise antibiotic use.
据估计，每年有400万新生儿死亡，其中大多数死于出生后的第一周。死亡的主要原因之一是败血症。证明新生儿败血症的发病率和病因很困难，尤其是在大多数死亡发生的资源匮乏地区。
我们对泰国-缅甸边境梅拉难民营绍克洛疟疾研究单位诊所接受产前护理的母亲所生婴儿进行了为期三年的临床诊断早发型（<7日龄）新生儿败血症（EONS）观察性研究。使用临床病例定义确定EONS发作。采用传统和分子微生物学技术以确定潜在病因。
从2009年4月至2012年4月，187名婴儿有EONS的临床体征，发病率为每1000例活产44.8例（95%可信区间38.7-51.5）。一份血培养大肠杆菌呈阳性，该婴儿的脑脊液标本中检测到大肠杆菌，另外两名婴儿通过聚合酶链反应也检测到大肠杆菌。因此，细菌学确诊的EONS发病率为每1000例活产0.7例（95%可信区间0.1-2.1）。参与研究的婴儿没有因EONS直接死亡。
尽管临床诊断的EONS发病率很高，但本研究中细菌学确诊EONS的发病率较低。需要在资源匮乏地区研究使用分子诊断方法和感染的非特异性标志物，以改善EONS的诊断并合理使用抗生素。
