Lee Soon Min, Chang Meayoung, Kim Ki-Soo
Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea.
Department of Pediatrics, School of Medicine, Chungnam National University, Daejeon, Korea.
J Korean Med Sci. 2015 Oct;30 Suppl 1(Suppl 1):S67-74. doi: 10.3346/jkms.2015.30.S1.S67. Epub 2015 Oct 27.
Neonatal sepsis remains one of the most important causes of death and co-morbidity in very-low-birth-weight (VLBW) infants. The aim of this study was to determine the current incidences of early-onset sepsis (EOS) and late-onset sepsis (LOS), the distribution of pathogens, and the impact of infection on co-morbidities in VLBW infants. We analyzed the data including sepsis episode from 2,386 VLBW infants enrolled in Korean Neonatal Network from January 2013 to June 2014. We defined EOS as a positive blood culture occurring between birth and 7 days of life and LOS after 7 days of life. Sepsis was found in 21.1% of VLBW infants. The risk of sepsis was inversely related to birth weight and gestational age. EOS was found in only 3.6% of VLBW infants, however the mortality rate was as high as 34.1%. EOS was associated with the increased odds for bronchopulmonary dysplasia and intraventricular hemorrhage. The vast majority of EOS was caused by Gram-positive organisms, particularly coagulase-negative staphylococci (30.6%). LOS developed in 19.4% of VLBW infants with a 16.1% mortality rate. Pathogens in LOS were dominated by coagulase-negative staphylococci (38.3%). Twenty-five percent and fifty percent of first LOS episode occurred after 12 days and 20 days from birth, respectively. Younger and smaller VLBW infants showed the earlier occurrence day for the 25% of first LOS episode. This study provides a recent nationwide epidemiology of sepsis in VLBW infants in Korea. Based on this study, successful strategies to reduce infections would improve survival and reduce morbidity.
新生儿败血症仍然是极低出生体重（VLBW）婴儿死亡和合并症的最重要原因之一。本研究的目的是确定极低出生体重婴儿早发型败血症（EOS）和晚发型败血症（LOS）的当前发病率、病原体分布以及感染对合并症的影响。我们分析了2013年1月至2014年6月纳入韩国新生儿网络的2386例极低出生体重婴儿的败血症发作数据。我们将早发型败血症定义为出生至出生后7天内血培养阳性，出生后7天以后为晚发型败血症。在21.1%的极低出生体重婴儿中发现了败血症。败血症风险与出生体重和胎龄呈负相关。仅3.6%的极低出生体重婴儿发生早发型败血症，但其死亡率高达34.1%。早发型败血症与支气管肺发育不良和脑室内出血的几率增加有关。绝大多数早发型败血症由革兰氏阳性菌引起，尤其是凝固酶阴性葡萄球菌（30.6%）。19.4%的极低出生体重婴儿发生晚发型败血症，死亡率为16.1%。晚发型败血症的病原体以凝固酶阴性葡萄球菌为主（38.3%）。分别有25%和50%的首次晚发型败血症发作发生在出生后12天和20天之后。年龄更小、体重更低的极低出生体重婴儿首次晚发型败血症发作的25%出现时间更早。本研究提供了韩国近期全国范围内极低出生体重婴儿败血症的流行病学情况。基于本研究，成功的感染防控策略将提高生存率并降低发病率。
