Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania, USA.
Arch Dis Child Fetal Neonatal Ed. 2021 May;106(3):298-304. doi: 10.1136/archdischild-2020-320221. Epub 2020 Nov 4.
To characterise the association between sepsis and postnatal weight growth when accounting for the degree of growth restriction present at birth.
Retrospective matched cohort study using data from the Postnatal Growth and Retinopathy of Prematurity study. Participants were born with birth weights of <1500 g or gestational ages of <32 weeks between 2006 and 2011 at 29 neonatal centres in the USA and Canada. Sepsis was defined as a culture-confirmed bacterial or fungal infection of the blood or cerebrospinal fluid before 36 weeks' postmenstrual age (PMA). Growth was assessed as the change in weight z-score between birth and 36 weeks' PMA.
Of 4785 eligible infants, 813 (17%) developed sepsis and 693 (85%) were matched 1:1 to controls. Sepsis was associated with a greater decline in weight z-score (mean difference -0.09, 95% CI -0.14 to -0.03). Postnatal weight growth failure (decline in weight z- score>1) was present in 237 (34%) infants with sepsis and 179 (26%) controls (adjusted OR 1.49, 95% CI 1.12 to 1.97). Longitudinal growth trajectories showed similar initial changes in weight z-scores between infants with and without sepsis. By 3 weeks after sepsis onset, there was a greater decline in weight z-scores relative to birth values in those with sepsis than without sepsis (delta z-score -0.89 vs -0.77; mean difference -0.12, 95% CI -0.18 to -0.05). This significant difference persisted until 36 weeks or discharge.
Infants with sepsis had similar early weight growth trajectories as infants without sepsis but developed significant deficits in weight that were not apparent until several weeks after the onset of sepsis.
在考虑出生时生长受限程度的情况下，描述败血症与产后体重增长之间的关系。
利用美国和加拿大 29 家新生儿中心 2006 年至 2011 年间出生体重<1500 克或胎龄<32 周的早产儿的出生后生长和早产儿视网膜病变研究的数据，进行回顾性匹配队列研究。败血症的定义为在 36 周校正胎龄（PMA）前，血或脑脊液中培养证实的细菌或真菌感染。生长评估为出生至 36 周 PMA 之间体重 z 评分的变化。
在 4785 名合格婴儿中，813 名（17%）发生败血症，693 名（85%）与对照组 1:1 匹配。败血症与体重 z 评分下降幅度更大有关（平均差值 -0.09，95%CI -0.14 至 -0.03）。败血症婴儿中 237 名（34%）和对照组 179 名（26%）存在体重增长失败（体重 z 评分下降>1）（调整比值比 1.49，95%CI 1.12 至 1.97）。纵向生长轨迹显示败血症患儿与无败血症患儿之间的体重 z 评分最初变化相似。在败血症发病后 3 周，与无败血症患儿相比，败血症患儿体重 z 评分较出生值下降更大（差值 z 评分 -0.89 比 -0.77；平均差值 -0.12，95%CI -0.18 至 -0.05）。这种显著差异一直持续到 36 周或出院。
患有败血症的婴儿与无败血症的婴儿有相似的早期体重增长轨迹，但在败血症发病后数周才出现明显的体重不足。
