Wynn James L
aDepartment of Pediatrics bDepartment of Pathology, Immunology, and Laboratory Medicine, University of Florida, Gainesville, Florida, USA.
Curr Opin Pediatr. 2016 Apr;28(2):135-40. doi: 10.1097/MOP.0000000000000315.
Although infection rates have modestly decreased in the neonatal intensive care unit (NICU) as a result of ongoing quality improvement measures, neonatal sepsis remains a frequent and devastating problem among hospitalized preterm neonates. Despite multiple attempts to address this unmet need, there have been minimal advances in clinical management, outcomes, and accuracy of diagnostic testing options over the last 3 decades. One strong contributor to a lack of medical progress is a variable case definition of disease. The inability to agree on a precise definition greatly reduces the likelihood of aligning findings from epidemiologists, clinicians, and researchers, which, in turn, severely hinders progress toward improving outcomes.
Pediatric consensus definitions for sepsis are not accurate in term infants and are not appropriate for preterm infants. In contrast to the defined multistage criteria for other devastating diseases encountered in the NICU (e.g., bronchopulmonary dysplasia), there is significant variability in the criteria used by investigators to substantiate the diagnosis of neonatal sepsis.
The lack of an accepted consensus definition for neonatal sepsis impedes our efforts toward improved diagnostic and prognostic options, and accurate outcomes information for this vulnerable population.
尽管由于持续的质量改进措施，新生儿重症监护病房（NICU）的感染率有所适度下降，但新生儿败血症仍是住院早产儿中常见且具有毁灭性的问题。尽管多次尝试满足这一未被满足的需求，但在过去30年里，临床管理、治疗结果以及诊断测试选项的准确性方面进展甚微。缺乏医学进展的一个重要原因是疾病的病例定义不统一。无法就精确的定义达成一致，极大地降低了流行病学家、临床医生和研究人员研究结果的一致性，进而严重阻碍了改善治疗结果的进程。
脓毒症的儿科共识定义在足月儿中并不准确，也不适用于早产儿。与NICU中其他严重疾病（如支气管肺发育不良）所定义的多阶段标准不同，研究人员用于证实新生儿败血症诊断的标准存在很大差异。
缺乏被广泛接受的新生儿败血症共识定义，阻碍了我们改善诊断和预后选项的努力，也无法为这一脆弱群体提供准确的治疗结果信息。
