Ussat M, Vogtmann C, Gebauer C, Pulzer F, Thome U, Knüpfer M
Children's Hospital, Department of Neonatology, University Hospital, Liebigstraße 20, 04103 Leipzig, Germany.
Children's Hospital, Department of Neonatology, University Hospital, Liebigstraße 20, 04103 Leipzig, Germany.
Early Hum Dev. 2015 Dec;91(12):677-81. doi: 10.1016/j.earlhumdev.2015.09.007. Epub 2015 Oct 27.
The study investigated the association between clinical symptoms and late-onset sepsis (LOS) in preterm infants with the aim of identifying a non-invasive tool for the early detection of LOS.
This was a prospective study of 83 episodes of suspected LOS in 67 preterm infants. At the time LOS was suspected, we recorded a standardized set of clinical symptoms. A diagnosis of "clinical LOS" (Clin-LOS), "culture-proven LOS" (Prov-LOS) or "LOS not present" (No-LOS) was made on the basis of C-reactive protein (CrP) and blood culture results where Clin-LOS was defined as CrP>10mg/l, Prov-LOS was defined as CrP>10mg/l AND positive blood cultures, or it was established that there was no sepsis present (No-LOS). We examined univariable associations between clinical signs and LOS using odds ratio (OR) analysis and then adjusted the odds ratio (adOR) through binary regression analysis.
Clin-LOS was diagnosed in 20/83 episodes, 19 cases were found to have Prov-LOS. Clinical signs which had a significant association with Clin-LOS were capillary refill time >2s (OR 2.9) and decreased responsiveness (OR 5.2), whereas there was a negative association between gastric residuals and LOS (OR 0.35). However, the most marked association was found for a greater central-peripheral temperature difference (cpTD) >2°C (OR 9). In Prov-LOS an increased heart rate (OR 3.1), prolonged capillary refill time (OR 3.3) and again an increased cpTD (OR 16) had a significant association with LOS, whereas gastric residuals were negatively associated (OR 0.29). Regression analysis showed that cpTD was the most striking clinical sign associated with both Clin- (adOR 6.3) and Prov-LOS (adOR 10.5).
Prolonged capillary refill time and - more impressive - elevated cpTD were the most useful clinical symptoms for detection of LOS in preterm infants. We especially suggest using cpTD as a predictor of LOS. It is a cheap, non-invasive and readily available tool for daily routines.
本研究调查了早产儿临床症状与晚发性败血症（LOS）之间的关联，旨在确定一种用于早期检测LOS的非侵入性工具。
这是一项对67例早产儿中83次疑似LOS发作的前瞻性研究。在怀疑LOS时，我们记录了一组标准化的临床症状。根据C反应蛋白（CrP）和血培养结果做出“临床LOS”（Clin-LOS）、“血培养证实的LOS”（Prov-LOS）或“无LOS”（No-LOS）的诊断，其中Clin-LOS定义为CrP>10mg/l，Prov-LOS定义为CrP>10mg/l且血培养阳性，或者确定不存在败血症（No-LOS）。我们使用比值比（OR）分析检查临床体征与LOS之间的单变量关联，然后通过二元回归分析调整比值比（adOR）。
83次发作中有20次被诊断为Clin-LOS，19例被发现患有Prov-LOS。与Clin-LOS有显著关联的临床体征是毛细血管再充盈时间>2秒（OR 2.9）和反应性降低（OR 5.2），而胃残余量与LOS之间存在负相关（OR 0.35）。然而，发现最显著的关联是中心-外周温差（cpTD）>2°C（OR 9）。在Prov-LOS中，心率加快（OR 3.1）、毛细血管再充盈时间延长（OR 3.3）以及再次出现的cpTD升高（OR 16）与LOS有显著关联，而胃残余量呈负相关（OR 0.29）。回归分析表明，cpTD是与Clin-LOS（adOR 6.3）和Prov-LOS（adOR 10.5）最显著相关的临床体征。
延长的毛细血管再充盈时间以及更显著的cpTD升高是检测早产儿LOS最有用的临床症状。我们特别建议将cpTD用作LOS的预测指标。它是一种用于日常常规检查的廉价、非侵入性且易于获得的工具。
