Newborn Services, Auckland City Hospital, Auckland, New Zealand.
Neonatal Medicine, Women's and Children's Hospital, Adelaide, South Australia, Australia.
BMJ Paediatr Open. 2022 Mar;6(1). doi: 10.1136/bmjpo-2022-001420.
Neonatal encephalopathy remains a major cause of infant mortality and neurodevelopmental impairment. Infection may exacerbate brain injury and mitigate the effect of therapeutic hypothermia (TH). Additionally, infants with sepsis treated with TH may be at increased risk of adverse effects. This study aimed to review the clinical characteristics and outcomes for infants with sepsis treated with TH.
Retrospective cohort study of infants treated with TH within Australia and New Zealand.
1522 infants treated with TH, including 38 with culture-positive sepsis from 2014 to 2018.
Anonymised retrospective review of data from Australian and New Zealand Neonatal Network. Infants with culture-positive sepsis within 48 hours were compared with those without sepsis.
Key outcomes include in-hospital mortality, intensive care support requirements and length of stay.
Overall the rate of mortality was similar between the groups (13% vs 13%). Infants with sepsis received a higher rate of mechanical ventilation (89% vs 70%, p=0.01), high-frequency oscillatory ventilation (32% vs 13%, p=0.003) and inhaled nitric oxide for persistent pulmonary hypertension (38% vs 16%, p<0.001). Additionally, the sepsis group had a longer length of stay (20 vs 11 days, p<0.001).
Infants with sepsis treated with TH required significantly more respiratory support and had a longer length of stay. Although this may suggest a more severe illness the rate of mortality was similar. Further research is warranted to review the neurodevelopmental outcomes for these infants.
新生儿脑病仍然是婴儿死亡和神经发育障碍的主要原因。感染可能会加重脑损伤，并减轻治疗性低体温（TH）的效果。此外，接受 TH 治疗的败血症婴儿可能会增加不良事件的风险。本研究旨在回顾接受 TH 治疗的败血症婴儿的临床特征和结局。
在澳大利亚和新西兰进行的接受 TH 治疗的婴儿的回顾性队列研究。
2014 年至 2018 年间，1522 名接受 TH 治疗的婴儿，包括 38 名培养阳性败血症婴儿。
对澳大利亚和新西兰新生儿网络的数据进行匿名回顾性审查。将 48 小时内培养阳性败血症的婴儿与无败血症的婴儿进行比较。
主要结局包括院内死亡率、重症监护支持需求和住院时间。
总体而言，两组死亡率相似（13% vs 13%）。败血症婴儿接受机械通气的比例更高（89% vs 70%，p=0.01）、高频振荡通气的比例更高（32% vs 13%，p=0.003）和吸入性一氧化氮治疗持续性肺动脉高压的比例更高（38% vs 16%，p<0.001）。此外，败血症组的住院时间更长（20 天 vs 11 天，p<0.001）。
接受 TH 治疗的败血症婴儿需要更多的呼吸支持，且住院时间更长。尽管这可能表明病情更严重，但死亡率相似。需要进一步研究来评估这些婴儿的神经发育结局。
