Universidade de São Paulo, Faculdade de Medicina, Instituto da Criança e do Adolescente, Unidade de Terapia Intensiva Neonatal, São Paulo, SP, Brazil.
Universidade de São Paulo, Faculdade de Medicina, Departamento de Pediatria, Divisão de Cirurgia Pediátrica, São Paulo, SP, Brazil.
J Pediatr (Rio J). 2022 Mar-Apr;98(2):168-174. doi: 10.1016/j.jped.2021.05.003. Epub 2021 Jun 18.
To analyze late-onset sepsis and to describe the etiological agents in newborns with gastroschisis.
A retrospective cohort, including newborns with gastroschisis whose admissions occurred in the period between January 2012 to December 2018 in a tertiary referral center. Maternal and newborn characteristics, surgical procedures and evolution in hospitalization were verified. A bivariate analysis was performed with patients with proven late-onset neonatal sepsis and according to the simple or complex gastroschisis category, the prevalent microorganisms in positive cultures were identified, statistical tests were carried out and the significance level adopted was p < 0,05. Results are presented in proportions, averages and standard deviation or medians. The level of significance adopted was p < 0.05.
101 newborns were analyzed, 45 (44.5%) were confirmed late-onset sepsis. The median birth weight was 2285+498 grams, and the gestational age was 35.9 +1.74weeks. The incidence of complex gastroschisis was 17.8%, the hospitalization time was 48.2+29.67 days and mortality was 9.9%. The newborns were divided into 2 groups: Group 1: late-onset sepsis (44.6%), and Group 2: no late-onset sepsis. The presence of complex gastroschisis was a factor associated with infection (p < 0.009). Fasting time (p < 0.001), parenteral nutrition time (p < 0.001), time to achieve full diet (p < 0.001), and hospitalization stay (p < 0.001) were higher in group 2. Gram-positive were the most frequent (51.1%), followed by Gram-negative (20%), and fungi (4.4%).
Newborns with gastroschisis have a higher risk of evolving with late-onset sepsis, despite this study did not calculate the risk of sepsis statistically, and the main germs detected by cultures were gram-positive bacteria, specifically Staphylococcus epidermidis.
分析晚发性败血症，并描述先天性腹裂新生儿的病因。
本回顾性队列研究纳入了 2012 年 1 月至 2018 年 12 月期间在一家三级转诊中心接受治疗的先天性腹裂新生儿。我们对母亲和新生儿的特征、手术过程以及住院期间的病情演变进行了验证。我们对已确诊患有晚发性新生儿败血症的患者进行了双变量分析，并根据简单或复杂腹裂的分类，确定阳性培养物中常见的微生物，进行了统计学检验，采用的显著性水平为 p<0.05。结果以比例、平均值和标准差或中位数表示。采用的显著性水平为 p<0.05。
共分析了 101 例新生儿，其中 45 例（44.5%）确诊为晚发性败血症。中位出生体重为 2285+498 克，胎龄为 35.9+1.74 周。复杂腹裂的发病率为 17.8%，住院时间为 48.2+29.67 天，死亡率为 9.9%。新生儿分为 2 组：组 1：晚发性败血症（44.6%），组 2：无晚发性败血症。复杂腹裂的存在是感染的相关因素（p<0.009）。组 2 的禁食时间（p<0.001）、肠外营养时间（p<0.001）、达到全肠内喂养时间（p<0.001）和住院时间（p<0.001）均较长。革兰氏阳性菌最为常见（51.1%），其次是革兰氏阴性菌（20%）和真菌（4.4%）。
先天性腹裂新生儿发生晚发性败血症的风险较高，尽管本研究未对败血症的风险进行统计学计算，但培养物中检测到的主要细菌是革兰氏阳性菌，尤其是表皮葡萄球菌。
