Doron M W, Makhlouf R A, Katz V L, Lawson E E, Stiles A D
Department of Pediatrics, University of North Carolina Hospitals, University of North Carolina at Chapel Hill 27599-7596.
J Pediatr. 1994 Sep;125(3):452-8. doi: 10.1016/s0022-3476(05)83294-9.
Neutropenia is often found at birth in infants born to mothers with preeclampsia, and is most likely present in utero. To determine whether this neutropenia is associated with an increased incidence of early-onset sepsis, we reviewed the hospital records of 301 low birth weight infants of mothers with preeclampsia. Early-onset sepsis was proved if the result of a culture of blood or cerebrospinal fluid in the first 48 hours of life was positive, or presumed if culture results were negative but two or more clinical signs of sepsis were present and the attending neonatologist believed that an infant was infected and needed at least 7 days of antibiotic therapy. Forty-eight percent of low birth weight infants of mothers with preeclampsia had neutropenia at less than 12 hours of age. Infants with neutropenia had mothers with more severe preeclampsia, were more premature (30 weeks vs 32 weeks), weighed less (1097 gm vs 1615 gm), and were more likely to be small for gestational age. Although maternal and obstetric risk factors for infection were less common in the group with neutropenia, rates of proven or presumed early-onset sepsis were higher (14% vs 2%; p < 0.001). Sepsis was proved in 6% of infants with neutropenia and in none of the infants without neutropenia (p = 0.03). A logistic regression analysis of the relative effects of birth weight, gestational age, and absolute neutrophil count on the incidence of sepsis revealed that only a low absolute neutrophil count correlated significantly with an increased risk of early-onset sepsis in infants with neutropenia.
中性粒细胞减少症常见于子痫前期母亲所生的婴儿出生时，很可能在子宫内就已存在。为了确定这种中性粒细胞减少症是否与早发性败血症的发病率增加有关，我们回顾了301例子痫前期母亲的低出生体重婴儿的医院记录。如果出生后48小时内血液或脑脊液培养结果为阳性，则证实为早发性败血症；如果培养结果为阴性，但存在两种或更多败血症临床体征，且主治新生儿科医生认为婴儿受到感染并需要至少7天的抗生素治疗，则推断为早发性败血症。48%的子痫前期母亲的低出生体重婴儿在出生后12小时内出现中性粒细胞减少症。中性粒细胞减少症婴儿的母亲子痫前期病情更严重，婴儿更早产（30周对32周），体重更轻（1,097克对1,615克），且更可能小于胎龄。虽然中性粒细胞减少症组中感染的母体和产科危险因素较少见，但已证实或推断的早发性败血症发生率较高（14%对2%；p<0.001）。6%的中性粒细胞减少症婴儿被证实患有败血症，而无中性粒细胞减少症的婴儿均未患败血症（p = 0.03）。对出生体重、胎龄和绝对中性粒细胞计数对败血症发生率的相对影响进行的逻辑回归分析显示，只有低绝对中性粒细胞计数与中性粒细胞减少症婴儿早发性败血症风险增加显著相关。
