Li Jinhui, Wu Jinlin, Du Lizhong, Hu Yong, Yang Xiaoyan, Mu Dezhi, Xia Bin
Department of Pediatrics, West China Second University Hospital, Sichuan University, No. 20 3rd Section of South Ren Ming Road, Chengdu, 610041, Sichuan, People's Republic of China,
Eur J Pediatr. 2015 Sep;174(9):1217-23. doi: 10.1007/s00431-015-2526-4. Epub 2015 Apr 2.
The purpose of this study is to determine the outcome and infection-related events in neonates with transient tachypnea of the newborn (TTN) managed with an antibiotic initiation strategy. An ambispective cohort study was carried out to compare two different antibiotic strategies in of TTN patients. The first strategy is based on clinical risk evaluation, in which antibiotics are initiated according to clinical signs, while the other is a combined strategy that integrates information regarding clinical signs, perinatal risk factors, and lab-based surveillance of infectious indicators. The antibiotic use in the combined strategy group (n = 716) was lower than that of the control group (n = 769) (35.06 vs 54.75 %, P < 0.01). Outcomes including total duration of antibiotic therapy (5.45 ± 4.17 vs 5.18 ± 3.45 days, P = 0.36), mortality (0 vs 0), length of hospital stay (7.78 ± 4.20 vs 8.14 ± 3.62 days, P = 0.07), and hospital readmission (4.89 vs 4.94 %, P = 0.94) did not differ; nor did infection-related events such as nosocomial infection (2.93 vs 2.99 %, P = 0.95), infectious pneumonia (18.30 vs 19.90 %, P = 0.43), septicemia (1.96 vs 1.95 %, P = 0.99), and necrotizing enterocolitis (0.14 vs 0.26 %).
The combined strategy effectively reduces antibiotic usage during incidences of TTN with no negative impact on the clinical outcome.
• TTN is easy to be confused with infection only based on clinical signs. • Many TTN patients had been treated with unnecessary antibiotics.
• Our combined strategy for TTN can reduce antibiotics usage. • New strategy did not increase the incidence of infection and adverse outcomes.
本研究旨在确定采用抗生素起始策略治疗的新生儿暂时性呼吸急促（TTN）患儿的治疗结果及感染相关事件。开展了一项回顾性队列研究，比较TTN患者的两种不同抗生素策略。第一种策略基于临床风险评估，根据临床体征开始使用抗生素，另一种是综合策略，整合了临床体征、围产期危险因素及基于实验室的感染指标监测等信息。联合策略组（n = 716）的抗生素使用率低于对照组（n = 769）（35.06% 对54.75%，P < 0.01）。包括抗生素治疗总时长（5.45 ± 4.17天对5.18 ± 3.45天，P = 0.36）、死亡率（0对0）、住院时长（7.78 ± 4.20天对8.14 ± 3.62天，P = 0.07）及再次入院率（4.89% 对4.94%，P = 0.94）等治疗结果并无差异；医院感染（2.93% 对2.99%，P = 0.95）、感染性肺炎（18.30% 对19.90%，P = 0.43）、败血症（1.96% 对1.95%，P = 0.99）及坏死性小肠结肠炎（0.14% 对0.26%）等感染相关事件也无差异。
联合策略可有效减少TTN发病期间的抗生素使用，且对临床结果无负面影响。
• 仅根据临床体征，TTN易与感染混淆。• 许多TTN患者接受了不必要的抗生素治疗。
• 我们针对TTN的联合策略可减少抗生素使用。• 新策略未增加感染及不良结局的发生率。
