Mishra Deepak, Das Amit Kumar, Chapagain Ram Hari, Jha Nitu Kumari, Rai Ganesh Kumar
Department of Paediatrics, Kanti Children's Hospital, Maharajgunj, Kathmandu, Nepal.
Indira Gandhi Memorial Hospital, Male, Maldives.
J Nepal Health Res Counc. 2019 Jan 28;16(41):401-404.
Most of the febrile infants <90 days old will have no more than a mild viral infection but there is a substantial minority that will be diagnosed as having serious bacterial infection at a reported prevalence of 10-14%. A simple, readily available, inexpensive diagnostic marker that yields results quickly and also accurately identifies bacterial infections in febrile infants would be of great value in management of these infants. This study aims to assess the role of thrombocytosis in predicting serious bacterial infection in young febrile infants beyond neonatal period.
A hospital based cross-sectional observational study was conducted from May 2016 to April 2017 on 76 febrile infants of age group 29-90 days in Kanti Children's Hospital.
The incidence of serious bacterial infection was found 43 (56.6%). Thrombocytosis, elevated C-reactive protein and pyuria were significantly higher in serious bacterial infection cases (p value <0.05). Thrombocytosis alone had the sensitivity of only 53.5%, but had specificity of 90.9%. Elevated C-reactive protein had the best sensitivity (81.4%). Combination of leukocytosis, elevated C-reactive protein, pyuria and thrombocytosis had better sensitivity (93.0%) than these parameters alone. The overall ability of platelet count to identify infants with SBI was only moderate (AUC: 0.722). Elevated C-reactive protein was found to have better ability to identify infants with serious bacterial infection (AUC: 0.846).
Thrombocytosis is a common finding in young infants diagnosed with serious bacterial infection. It has however, moderate ability in identifying infants with serious bacterial infection. Combining thrombocytosis with elevated C-reactive protein, leukocytosis and pyuria has better sensitivity in diagnosing serious bacterial infection than these individual parameters alone. Hence, combining these parameters may help in early prediction of febrile young infants at risk of serious bacterial infection.
大多数90日龄以下的发热婴儿只会发生不超过轻度的病毒感染，但有相当一部分会被诊断为患有严重细菌感染，据报告患病率为10%-14%。一种简单、易于获得、价格低廉且能快速得出结果并准确识别发热婴儿细菌感染的诊断标志物，对于这些婴儿的管理具有重要价值。本研究旨在评估血小板增多症在预测新生儿期以外的发热幼儿严重细菌感染中的作用。
2016年5月至2017年4月，在坎蒂儿童医院对76名年龄在29-90日龄的发热婴儿进行了一项基于医院的横断面观察性研究。
发现严重细菌感染的发生率为43例（56.6%）。严重细菌感染病例中血小板增多症、C反应蛋白升高和脓尿症显著更高（p值<0.05）。仅血小板增多症的敏感性仅为53.5%，但特异性为90.9%。C反应蛋白升高具有最佳敏感性（81.4%）。白细胞增多、C反应蛋白升高、脓尿症和血小板增多症联合使用的敏感性（93.0%）优于单独使用这些参数。血小板计数识别患有严重细菌感染婴儿的总体能力仅为中等（曲线下面积：0.722）。发现C反应蛋白升高识别患有严重细菌感染婴儿的能力更好（曲线下面积：0.846）。
血小板增多症在诊断为严重细菌感染的幼儿中是常见表现。然而，其识别患有严重细菌感染婴儿的能力中等。将血小板增多症与C反应蛋白升高、白细胞增多和脓尿症联合使用，在诊断严重细菌感染方面比单独使用这些个体参数具有更好的敏感性。因此，联合这些参数可能有助于早期预测有严重细菌感染风险的发热幼儿。
