Neonatal Directorate, King Edward Memorial Hospital, Child and Adolescent Health Service, Perth, WA, Australia; Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, University of Western Australia, Perth, WA, Australia.
Discipline of Paediatrics, Trinity College, University of Dublin and Trinity Research in Childhood Centre, Dublin, Ireland; Children's Health Hospital at Tallaght, Tallaght University Hospital, Dublin, Ireland; Trinity Translational Medicine Institute, St James Hospital, Dublin, Ireland; Neonatology, Children's Health Hospital at Crumlin, Dublin, Ireland; Paediatrics, Coombe Women's and Infant's University Hospital, Dublin, Ireland.
Lancet. 2024 Jul 20;404(10449):277-293. doi: 10.1016/S0140-6736(24)00495-1. Epub 2024 Jun 26.
Neonatal sepsis remains one of the key challenges of neonatal medicine, and together with preterm birth, causes almost 50% of all deaths globally for children younger than 5 years. Compared with advances achieved for other serious neonatal and early childhood conditions globally, progress in reducing neonatal sepsis has been much slower, especially in low-resource settings that have the highest burden of neonatal sepsis morbidity and mortality. By contrast to sepsis in older patients, there is no universally accepted neonatal sepsis definition. This poses substantial challenges in clinical practice, research, and health-care management, and has direct practical implications, such as diagnostic inconsistency, heterogeneous data collection and surveillance, and inappropriate treatment, health-resource allocation, and education. As the clinical manifestation of neonatal sepsis is frequently non-specific and the current diagnostic standard blood culture has performance limitations, new improved diagnostic techniques are required to guide appropriate and warranted antimicrobial treatment. Although antimicrobial therapy and supportive care continue as principal components of neonatal sepsis therapy, refining basic neonatal care to prevent sepsis through education and quality improvement initiatives remains paramount.
新生儿败血症仍然是新生儿医学的主要挑战之一，与早产一起，导致全球 5 岁以下儿童死亡人数达到近 50%。与全球其他严重新生儿和儿童早期疾病取得的进展相比，降低新生儿败血症的进展要慢得多，特别是在资源匮乏的环境中，这些环境中新生儿败血症发病率和死亡率最高。与老年患者的败血症不同，目前还没有普遍接受的新生儿败血症定义。这在临床实践、研究和医疗保健管理方面带来了重大挑战，并具有直接的实际意义，例如诊断不一致、数据收集和监测异质性以及不适当的治疗、卫生资源分配和教育。由于新生儿败血症的临床表现通常不具有特异性，并且目前的诊断标准血液培养存在性能限制，因此需要新的改进的诊断技术来指导适当和必要的抗生素治疗。尽管抗生素治疗和支持性护理仍然是新生儿败血症治疗的主要组成部分，但通过教育和质量改进措施来细化基本的新生儿护理以预防败血症仍然至关重要。
