Grill Agnes, Olischar Monika, Weber Michael, Unterasinger Lukas, Berger Angelika, Leitich Harald
Department of Pediatrics and Adolescent Medicine, Medical University of Vienna, 1090 Vienna, Austria.
Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, 1090 Vienna, Austria.
J Clin Med. 2021 Sep 30;10(19):4539. doi: 10.3390/jcm10194539.
Culture-proven sepsis is the gold standard in early-onset neonatal sepsis diagnosis. Infants born ≤29 weeks gestation after preterm rupture of membranes in the years 2009-2015 were included in a retrospective cohort study performed at a level III fetal-maternal unit. The study aimed to compare culture-proven sepsis, clinical sepsis and positive laboratory biomarkers ≤72 h as predictors of mortality before discharge and the combined outcome of mortality or severe short-term morbidity (severe cerebral morbidity, bronchopulmonary dysplasia and retinopathy).
Of the 354 patients included, culture-proven sepsis, clinical sepsis and laboratory biomarkers were positive in 2.3%, 8.5% and 9.6%, respectively. The mortality rate was 37.5% for patients with culture-proven sepsis (3/8), 33.3% for patients with clinical sepsis (10/30) and 8.8% for patients with positive laboratory biomarkers (3/34), respectively. Mortality or severe morbidity occurred in 75.0% of patients with culture-proven sepsis (6/8), 80.0% of patients with clinical sepsis (24/30) and 44.1% of patients with positive laboratory biomarkers (15/34), respectively.
In preterm infants after preterm rupture of membranes, clinical sepsis was almost four times more common and at least equally valuable in predicting mortality and mortality or severe morbidity compared to culture-proven sepsis.
经培养证实的败血症是早发型新生儿败血症诊断的金标准。2009年至2015年间，孕周≤29周且胎膜早破的婴儿被纳入一项在三级母婴单位进行的回顾性队列研究。该研究旨在比较经培养证实的败血症、临床败血症以及≤72小时的实验室生物标志物阳性作为出院前死亡率和死亡或严重短期发病率（严重脑损伤、支气管肺发育不良和视网膜病变）综合结局预测指标的情况。
在纳入的354例患者中，经培养证实的败血症、临床败血症和实验室生物标志物阳性的比例分别为2.3%、8.5%和9.6%。经培养证实的败血症患者死亡率为37.5%（3/8），临床败血症患者为33.3%（10/30），实验室生物标志物阳性患者为8.8%（3/34）。经培养证实的败血症患者中75.0%（6/8）发生了死亡或严重发病，临床败血症患者中80.0%（24/30），实验室生物标志物阳性患者中44.1%（15/34）。
在胎膜早破的早产儿中，临床败血症的发生率几乎是经培养证实的败血症的四倍，并且在预测死亡率以及死亡或严重发病方面至少与经培养证实的败血症具有同等价值。
