外观健康新生儿感染筛查与早期未结合高胆红素血症的关系。

Relationship between infectious screening and early unconjugated hyperbilirubinemia in well-appearing neonates.

机构信息

Division of Neonatology, Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan, ROC.

Institute of Bio-Medical Informatics, National Yang-Ming University, Taipei, Taiwan, ROC.

出版信息

J Chin Med Assoc. 2020 Apr;83(4):406-410. doi: 10.1097/JCMA.0000000000000290.

DOI:10.1097/JCMA.0000000000000290

PMID:32132385

Abstract

BACKGROUND

Neonatal hyperbilirubinemia (NH) may be the initial and solitary sign of infectious condition in neonates. This retrospective cohort study aims to evaluate the risk of sepsis or urinary tract infection in well-appearing infants with NH below 7 days old.

METHODS

All neonates (n = 8779) born in Taipei Veterans General Hospital from 2013 to 2017 were evaluated retrospectively. A total of 2523 initially well-appearing babies were admitted because of NH. After being hospitalized, patients were categorized into two groups according to the initial transcutaneous bilirubin (TCB) level. Infectious screening results, which include C-reactive protein (CRP), differential count, blood culture, urinalysis, and urine culture, were analyzed.

RESULTS

Regarding CRP, 2.7% (18/667) of neonates with NH had elevated CRP (≥1 mg/dL). Among 547 blood cultures, eight were positive, with 0.4% (2/547) non-coagulase-negative staphylococcus (CoNS) bacteremia and 1.1% (6/547) CoNS bacteremia. In urinalysis, 16.6% (182/1094) of NH neonates had pyuria, and 6.7% (25/372) had positive urine cultures. NH with a higher initial TCB level was related to an increased chance of elevated CRP (4.7% vs. 1.5%, odds ratio: 3.29, p = 0.024) and pyuria (20.6% vs. 12.6%, odds ratio: 1.79, p < 0.001). The rate of positive urine culture between the higher and lower TCB groups had no significant difference (6.6% vs. 6.9%, p > 0.99). Significant bacteriuria was more common in NH neonates admitted at later age (>2 days) (4.9% vs. 11.5%, p = 0.035).

CONCLUSION

In well-appearing neonates below 7 days old, NH with a higher initial TCB is associated with an increased rate in pyuria and abnormal CRP. No difference was found in the rate of positive urine culture between higher and lower TCB levels. Significant bacteriuria was more common in older NH neonates. Septicemia is rare among well-appearing neonates with NH.

摘要

背景

新生儿高胆红素血症（NH）可能是新生儿感染性疾病的最初且唯一表现。本回顾性队列研究旨在评估出生后 7 天内外观良好的 NH 患儿发生败血症或尿路感染的风险。

方法

评估了 2013 年至 2017 年在台北荣民总医院出生的所有新生儿（n=8779）。共有 2523 名外观良好的婴儿因 NH 住院。住院后，根据初始经皮胆红素（TCB）水平将患者分为两组。分析了包括 C 反应蛋白（CRP）、差异计数、血培养、尿液分析和尿液培养在内的感染筛查结果。

结果

在 CRP 方面，2.7%（18/667）的 NH 患儿 CRP 升高（≥1mg/dL）。547 份血培养中，有 8 份为阳性，其中凝固酶阴性葡萄球菌（CoNS）菌血症占 0.4%（2/547），CoNS 菌血症占 1.1%（6/547）。尿液分析显示，16.6%（182/1094）的 NH 新生儿有脓尿，6.7%（25/372）有阳性尿液培养。初始 TCB 水平较高的 NH 与 CRP 升高（4.7% vs. 1.5%，优势比：3.29，p=0.024）和脓尿（20.6% vs. 12.6%，优势比：1.79，p<0.001）的几率增加有关。较高和较低 TCB 组之间阳性尿液培养的比率没有显著差异（6.6% vs. 6.9%，p>0.99）。年龄较大（>2 天）的 NH 新生儿中，明显菌尿更为常见（4.9% vs. 11.5%，p=0.035）。