Cincinnati Children's Hospital Medical Center and the Department of Pediatrics, University of Cincinnati College of Medicine, 3333 Burnet Ave Cincinnati OH 45229, Cincinnati, OH, USA.
Arkansas Children's Hospital and Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
J Perinatol. 2022 Nov;42(11):1453-1457. doi: 10.1038/s41372-022-01494-3. Epub 2022 Aug 20.
Early onset infection (EOI) in gastroschisis is rare. Excess antibiotic exposure in neonates increases necrotizing enterocolitis and mortality. We evaluated antibiotic exposure and EOI in gastroschisis.
Retrospective cohort analysis between 2010-2016 in the Children's Hospital Neonatal Database. Included: Infants ≥32 weeks with gastroschisis admitted <48 h. Excluded: major anomalies or surgical intervention prior to admission.
EOI diagnosis (<72 h).
In 2021 patients with gastroschisis, median gestational age was 36 weeks (IQR 35, 37). 93.9% patients received empiric antibiotics after delivery, with median 7 days duration (IQR 3, 9). Only 13 patients (0.64%) had early positive blood culture. The rate of late onset blood stream infection (7.08%) was higher, and higher in complex (18%) than simple gastroschisis (4.8%, p < 0.001).
Despite low incidence of EOI and risks of excess antibiotic exposure, neonates with gastroschisis are exposed to long courses of empiric antibiotics. These data should stimulate interinstitution work to improve antibiotic prescribing.
先天性脐膨出患儿的早期感染（EOI）较为罕见。新生儿过度使用抗生素会增加坏死性小肠结肠炎和死亡率。本研究旨在评估先天性脐膨出患儿的抗生素使用情况与 EOI 之间的关系。
对 2010 年至 2016 年间儿童医院新生儿数据库中的病例进行回顾性队列分析。纳入标准：胎龄≥32 周、生后<48 小时内入院且存在先天性脐膨出的患儿。排除标准：存在严重畸形或入院前已接受外科干预的患儿。
EOI 诊断（<72 小时）。
在 2021 例先天性脐膨出患儿中，中位胎龄为 36 周（IQR 35，37）。出生后 93.9%的患儿接受了经验性抗生素治疗，中位疗程为 7 天（IQR 3，9）。仅有 13 例（0.64%）患儿的血培养结果为早期阳性。晚发性血流感染（7.08%）的发生率更高，且复杂性脐膨出（18%）高于单纯性脐膨出（4.8%，p<0.001）。
尽管 EOI 的发生率较低且存在过度使用抗生素的风险，但患有先天性脐膨出的新生儿仍接受了长时间的经验性抗生素治疗。这些数据应促使各医疗机构共同努力，以改善抗生素的使用。
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