新冠疫情期间极早产儿的晚发性败血症

Late-Onset Sepsis Among Extremely Preterm Infants During the COVID-19 Pandemic.

作者信息

Mukhopadhyay Sagori, Kaufman David A, Saha Shampa, Puopolo Karen M, Flannery Dustin D, Weimer Kristin E D, Greenberg Rachel G, Sanchez Pablo J, Eichenwald Eric C, Cotten Charles M, Stoll Barbara J, Laptook Abbot

机构信息

Division of Neonatology, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.

Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania.

出版信息

Pediatrics. 2025 Feb 1;155(2). doi: 10.1542/peds.2024-067675.

DOI:10.1542/peds.2024-067675

PMID:39842471

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11908436/

Abstract

OBJECTIVES

To compare incidence of late-onset sepsis (LOS) among extremely preterm infants before and during the COVID-19 pandemic.

METHODS

Multicenter cohort study of infants with birthweight 401 to 1000 g or gestational age 22 to 28 weeks. LOS was defined as a bacterial or fungal pathogen isolated from blood or cerebrospinal fluid culture obtained after 72 hours of age. Primary outcome was LOS incidence calculated as incidence proportion (LOS cases among all admissions) and incidence rate (LOS events/1000 patient days). A multivariable Poisson regression model was used to compare the adjusted risk of LOS incidence proportion before (1/1/18-3/31/20) and during the pandemic (4/1/20-12/31/21). An interrupted time series analysis using a generalized linear mixed model with center as a random effect was used to compare LOS incidence rates during the 2 periods.

RESULTS

Among 6509 eligible infants, LOS incidence proportion was not different before (18.2%) and during the pandemic (16.9%; P = .18). The adjusted relative risk (95% CI) for LOS was 0.93 (0.82-1.05) and for LOS or mortality was 0.98 (0.88-1.08) during the pandemic compared to the period before the pandemic. In the interrupted time series analysis, there was no significant change in LOS incidence rates at the start of the pandemic (0.219, 95% CI, -0.453 to 0.891) or microbiology of LOS, and change in trends of LOS incidence rates before and during the pandemic was not significant (-0.005, 95% CI, -0.025 to 0.015).

CONCLUSIONS

In a large multicenter study of extremely preterm infants, rates of LOS remained unchanged during the pandemic.

摘要

目的

比较2019冠状病毒病（COVID-19）大流行之前及期间极早产儿晚发性败血症（LOS）的发病率。

方法

对出生体重401至1000克或胎龄22至28周的婴儿进行多中心队列研究。LOS定义为在出生72小时后从血液或脑脊液培养物中分离出的细菌或真菌病原体。主要结局是LOS发病率，计算为发病比例（所有入院病例中的LOS病例）和发病率（LOS事件/1000患者日）。使用多变量泊松回归模型比较大流行之前（2018年1月1日至2020年3月31日）和期间（2020年4月1日至2021年12月31日）LOS发病比例的调整风险。使用以中心为随机效应的广义线性混合模型进行中断时间序列分析，以比较两个时期的LOS发病率。

结果

在6509名符合条件的婴儿中，大流行之前（18.2%）和期间（16.9%；P = 0.18）的LOS发病比例没有差异。与大流行之前相比，大流行期间LOS的调整相对风险（95%CI）为0.93（0.82 - 1.05），LOS或死亡率的调整相对风险为0.98（0.88 - 1.08）。在中断时间序列分析中，大流行开始时LOS发病率（0.219，95%CI，-0.453至0.891）或LOS微生物学没有显著变化，大流行之前和期间LOS发病率趋势的变化也不显著（-0.005，95%CI，-0.025至0.015）。