澳大利亚和新西兰新生儿重症监护病房收治的新生儿先天性异常与迟发性细菌感染之间的关联：一项基于人群的队列研究
Association between Congenital Anomalies and Late-Onset Bacterial Infections in Neonates Admitted to Neonatal Intensive Care Units in Australia and New Zealand: A Population-Based Cohort Study.
作者信息
Chughtai Abrar Ahmad, Spotswood Naomi, Strunk Tobias, Parmar Trisha, Schindler Tim, Popat Himanshu, Chow Sharon Sue Wen, Lui Kei
机构信息
School of Population Health, University of New South Wales, Sydney, New South Wales, Australia,
Women's and Children's Services, Royal Hobart Hospital, Hobart, Tasmania, Australia.
出版信息
Neonatology. 2025;122(1):95-105. doi: 10.1159/000540276. Epub 2024 Sep 19.
INTRODUCTION
Compromised neonatal intensive care unit neonates are at risk of acquiring late-onset infections (late-onset sepsis [LOS]). Neonates born with congenital anomalies (CAs) could have an additional LOS risk.
METHODS
Utilising the population-based Australian and New Zealand Neonatal Network data from 2007 to 2017, bacterial LOS rates were determined in very preterm (VPT, <32 week), moderately preterm (MPT, 32-36 weeks), and term (FT, 37-41 weeks) neonates with or without CA. Stratified by major surgery, the association between CA and bacterial LOS was evaluated.
RESULTS
Of 102,808 neonates, 37.7%, 32.8%, and 29.6% were born VPT, MPT, and FT, respectively. Among these, 3.4% VPT, 7.5% MPT, and 16.2% FT neonates had CA. VPT neonates had the highest LOS rate (11.1%), compared to MPT (1.8%) and FT (1.8%) neonates. LOS rates were higher in CA neonates than those without (8.2% versus 5.1% adjusted relative risk [aRR] 1.67, 95% confidence interval [CI]: 1.45-1.92). Neonates with surgery had a higher LOS rate (14.2%) than neonates without surgery (4.4%, p < 0.001). Among the neonates without surgery, CA neonates had consistently higher LOS rates than those without CA (VPT 14.3% vs. 9.6% [aRR 1.32, 95% CI: 1.11-1.57]; MPT 4% vs. 0.9% [aRR 4.45, 95% CI: 3.23-6.14]; and FT 2% vs. 0.7% [aRR 2.87, 95% CI: 1.97-4.18]). For the neonates with surgery, CAs were not associated with additional LOS risks.
CONCLUSION
Overall, we reported higher rates of LOS in neonates with CA compared to those without CA. Regardless of gestation, CA was associated with an increased LOS risk among non-surgical neonates. Optimisation of infection prevention strategies for CA neonates should be explored. Future studies are needed to evaluate if the infection risk is caused by CA or associated complications.
INTRODUCTION
Compromised neonatal intensive care unit neonates are at risk of acquiring late-onset infections (late-onset sepsis [LOS]). Neonates born with congenital anomalies (CAs) could have an additional LOS risk.
METHODS
Utilising the population-based Australian and New Zealand Neonatal Network data from 2007 to 2017, bacterial LOS rates were determined in very preterm (VPT, <32 week), moderately preterm (MPT, 32-36 weeks), and term (FT, 37-41 weeks) neonates with or without CA. Stratified by major surgery, the association between CA and bacterial LOS was evaluated.
RESULTS
Of 102,808 neonates, 37.7%, 32.8%, and 29.6% were born VPT, MPT, and FT, respectively. Among these, 3.4% VPT, 7.5% MPT, and 16.2% FT neonates had CA. VPT neonates had the highest LOS rate (11.1%), compared to MPT (1.8%) and FT (1.8%) neonates. LOS rates were higher in CA neonates than those without (8.2% versus 5.1% adjusted relative risk [aRR] 1.67, 95% confidence interval [CI]: 1.45-1.92). Neonates with surgery had a higher LOS rate (14.2%) than neonates without surgery (4.4%, p < 0.001). Among the neonates without surgery, CA neonates had consistently higher LOS rates than those without CA (VPT 14.3% vs. 9.6% [aRR 1.32, 95% CI: 1.11-1.57]; MPT 4% vs. 0.9% [aRR 4.45, 95% CI: 3.23-6.14]; and FT 2% vs. 0.7% [aRR 2.87, 95% CI: 1.97-4.18]). For the neonates with surgery, CAs were not associated with additional LOS risks.
CONCLUSION
Overall, we reported higher rates of LOS in neonates with CA compared to those without CA. Regardless of gestation, CA was associated with an increased LOS risk among non-surgical neonates. Optimisation of infection prevention strategies for CA neonates should be explored. Future studies are needed to evaluate if the infection risk is caused by CA or associated complications.
引言
新生儿重症监护病房中身体状况不佳的新生儿有发生晚发性感染（晚发性败血症[LOS]）的风险。患有先天性异常（CA）的新生儿可能有额外的LOS风险。
方法
利用2007年至2017年基于人群的澳大利亚和新西兰新生儿网络数据，确定了患有或未患有CA的极早产儿（VPT，<32周）、中度早产儿（MPT，32 - 36周）和足月儿（FT，37 - 41周）的细菌性LOS发生率。按大手术分层，评估CA与细菌性LOS之间的关联。
结果
在102,808例新生儿中，分别有37.7%、32.8%和29.6%为VPT、MPT和FT出生。其中，3.4%的VPT、7.5%的MPT和16.2%的FT新生儿患有CA。VPT新生儿的LOS发生率最高（11.1%），而MPT（1.8%）和FT（1.8%）新生儿的LOS发生率较低。CA新生儿的LOS发生率高于无CA的新生儿（8.2%对5.1%，调整后相对风险[aRR] 1.67，95%置信区间[CI]：1.45 - 1.92）。接受手术的新生儿的LOS发生率高于未接受手术的新生儿（14.2%对4.4%，p < 0.001）。在未接受手术的新生儿中，CA新生儿的LOS发生率始终高于无CA的新生儿（VPT为14.3%对9.6% [aRR 1.32，95% CI：1.11 - 1.57]；MPT为4%对0.9% [aRR 4.45，95% CI：3.23 - 6.14]；FT为2%对0.7% [aRR 2.87，95% CI：1.97 - 4.18]）。对于接受手术的新生儿，CA与额外的LOS风险无关。
结论
总体而言，我们报告患有CA的新生儿的LOS发生率高于无CA的新生儿。无论孕周如何，CA与非手术新生儿中LOS风险增加相关。应探索优化CA新生儿感染预防策略。未来需要进行研究以评估感染风险是由CA还是相关并发症引起的。
引言
新生儿重症监护病房中身体状况不佳的新生儿有发生晚发性感染（晚发性败血症[LOS]）的风险。患有先天性异常（CA）的新生儿可能有额外的LOS风险。
方法
利用2007年至2017年基于人群的澳大利亚和新西兰新生儿网络数据，确定了患有或未患有CA的极早产儿（VPT，<32周）、中度早产儿（MPT，32 - 36周）和足月儿（FT，37 - 41周）的细菌性LOS发生率。按大手术分层，评估CA与细菌性LOS之间的关联。
结果
在102,808例新生儿中，分别有37.7%、32.8%和29.6%为VPT、MPT和FT出生。其中，3.4%的VPT、7.5%的MPT和16.2%的FT新生儿患有CA。VPT新生儿的LOS发生率最高（11.1%），而MPT（1.8%）和FT（1.8%）新生儿的LOS发生率较低。CA新生儿的LOS发生率高于无CA的新生儿（8.2%对5.1%，调整后相对风险[aRR] 1.67，95%置信区间[CI]：1.45 - 1.92）。接受手术的新生儿的LOS发生率高于未接受手术的新生儿（14.2%对4.4%，p < 0.001）。在未接受手术的新生儿中，CA新生儿的LOS发生率始终高于无CA的新生儿（VPT为14.3%对9.6% [aRR 1.32，95% CI：1.11 - 1.57]；MPT为4%对0.9% [aRR 4.45，95% CI：3.23 - 6.14]；FT为2%对0.7% [aRR 2.87，95% CI：1.97 - 4.18]）。对于接受手术的新生儿，CA与额外的LOS风险无关。
结论
总体而言，我们报告患有CA的新生儿的LOS发生率高于无CA的新生儿。无论孕周如何，CA与非手术新生儿中LOS风险增加相关。应探索优化CA新生儿感染预防策略。未来需要进行研究以评估感染风险是由CA还是相关并发症引起的。
Zotero 插件