Williams Sadie L, Leonard Matthew, Hall Eric S, Perez Jose, Wessel Jacqueline, Kingma Paul S
Section of Neonatology, Perinatal and Pulmonary Biology, Perinatal Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
Division of Nutrition Therapy, Cincinnati Children's Hospital Medical Center, Winnie Palmer Hospital, Orlando, Florida.
Am J Perinatol. 2018 Mar;35(4):385-389. doi: 10.1055/s-0037-1607420. Epub 2017 Oct 30.
Gastroschisis is a congenital defect in which the abdominal viscera herniate through the abdominal wall. In this population, antibiotics are often initiated immediately following delivery; however, this may be unnecessary as infections typically develop as a consequence of chronic issues in gastroschisis. The objective of this study was to evaluate the incidence of culture positive early onset sepsis, the reliability of the immature to mature neutrophil count (I:T) ratio as an infectious biomarker, and antibiotic use in infants with gastroschisis.
This retrospective chart review analyzed clinical data from 103 infants with gastroschisis and 103 weight-matched controls that were evaluated for early onset infection.
Compared with the control group, there was a significantly increased percentage of infants with an I:T ratio > 0.2 in the gastroschisis group (43% vs. 12%, < 0.001) and an increased percentage of infants exposed to greater than 5 days of antibiotics regardless of their I:T ratio (75% vs. 6%, < 0.001). There were no episodes of culture positive early onset sepsis in either group.
Our results indicate that I:T ratio is not a reliable marker of infection in gastroschisis, and suggest that empiric septic evaluation and antibiotic use, immediately following delivery in gastroschisis infants, may be unnecessary.
腹裂是一种先天性缺陷，腹腔内脏器通过腹壁疝出。在这一群体中，抗生素通常在分娩后立即开始使用；然而，这可能是不必要的，因为感染通常是腹裂慢性问题的结果。本研究的目的是评估培养阳性早发性败血症的发生率、未成熟与成熟中性粒细胞计数（I:T）比值作为感染生物标志物的可靠性，以及腹裂婴儿的抗生素使用情况。
这项回顾性图表审查分析了103例腹裂婴儿和103例体重匹配的对照婴儿的临床数据，这些婴儿接受了早发性感染评估。
与对照组相比，腹裂组中I:T比值>0.2的婴儿百分比显著增加（43%对12%，<0.001），无论I:T比值如何，暴露于抗生素超过5天的婴儿百分比增加（75%对6%，<0.001）。两组均无培养阳性早发性败血症发作。
我们的结果表明，I:T比值不是腹裂感染的可靠标志物，并表明在腹裂婴儿分娩后立即进行经验性败血症评估和使用抗生素可能是不必要的。
