Division of Neonatology, Department of Pediatrics, Willem Alexander Children's Hospital, Leiden University Medical Center (LUMC), Leiden, The Netherlands.
Department of Hematology, Center for Clinical Transfusion Research, Amsterdam, The Netherlands.
Transfusion. 2023 Jan;63(1):117-124. doi: 10.1111/trf.17176. Epub 2022 Nov 5.
Among neonates with hemolytic disease of the fetus and newborn (HDFN), we aimed to describe the frequency of central-line use, indications for insertion, and incidence of confirmed and suspected sepsis, including antibiotic treatment over a 10-year surveillance period.
All neonates with HDFN admitted to our neonatal intensive care unit between January 2012 and December 2021 were included in this retrospective, cohort study. Annual proportions of infants with a central-line and central-line-associated bloodstream infection (CLABSI) rates (per 1000 central-line days and per 100 infants) were evaluated. Numbers of confirmed and suspected early- and late-onset sepsis episodes were assessed over the entire study period.
Of the 260 included infants, 25 (9.6%) were evaluated for suspected sepsis, with 16 (6.2%) having ≥1 confirmed sepsis episode. A total of 123 central-lines were placed in 98 (37.7%) neonates, with impending exchange transfusion (ET) being the most frequent indication. Of the 34 (34.7%) neonates in whom a central-line was placed due to impending ET, 11 (32.4%) received no ET. Overall CLABSI incidence was 13.58 per 1000 central-line days. Neonates with a central-line had a higher risk for confirmed late-onset infection (RR 1.11, 95% CI: 1.04-1.20) and sepsis work-up (RR 1.10, 95% CI: 1.03-1.17) compared to infants without a central-line.
Sepsis incidence among neonates with HDFN remains high, in particular in those with a central-line. Considering the substantial proportion of neonates with a central-line without eventual ET, central-line placement should be delayed until the likelihood of ET is high.
在患有胎儿和新生儿溶血病（HDFN）的新生儿中，我们旨在描述中心静脉置管的使用频率、置管指征以及确诊和疑似败血症的发生率，包括在 10 年监测期间接受抗生素治疗的情况。
本回顾性队列研究纳入了 2012 年 1 月至 2021 年 12 月期间入住我院新生儿重症监护病房的所有 HDFN 新生儿。评估每年使用中心静脉置管的婴儿比例和中心静脉置管相关血流感染（CLABSI）发生率（每 1000 个中心静脉置管日和每 100 例婴儿）。在整个研究期间，评估了确诊和疑似早发性和晚发性败血症发作的次数。
在 260 例纳入的婴儿中，有 25 例（9.6%）被评估为疑似败血症，其中 16 例（6.2%）有≥1 例确诊败血症发作。共有 98 例（37.7%）新生儿放置了 123 根中心静脉置管，其中即将进行换血治疗（ET）是最常见的指征。在因即将进行 ET 而放置中心静脉置管的 34 例（34.7%）新生儿中，有 11 例（32.4%）未进行 ET。总的 CLABSI 发生率为每 1000 个中心静脉置管日 13.58 例。与无中心静脉置管的婴儿相比，有中心静脉置管的婴儿发生确诊晚发性感染（RR 1.11，95%CI：1.04-1.20）和进行败血症检查（RR 1.10，95%CI：1.03-1.17）的风险更高。
患有 HDFN 的新生儿败血症的发生率仍然很高，尤其是那些有中心静脉置管的新生儿。考虑到有相当一部分有中心静脉置管但最终没有进行 ET 的新生儿，应延迟中心静脉置管，直到 ET 的可能性很高。
