Rodwell R L, Taylor K M, Tudehope D I, Gray P H
Hematology Department Mater Misericordiae Hospitals, South Brisbane, Australia.
Pediatr Infect Dis J. 1993 May;12(5):372-6. doi: 10.1097/00006454-199305000-00004.
The hematologic profiles of 1000 newborns were prospectively examined to identify infants with neutropenia (N = 170) according to the system of Manroe et al. (J Pediatr 1979;95:89-98) and to evaluate a hematologic scoring system (Rodwell et al. J Pediatr 1988;112:761-7) as a screening test for sepsis. Neutropenia was more commonly of noninfectious than infectious origin (83.5% vs. 16.5%; P < 0.001). On the initial test a positive screen (scores > or = 3) identified 26 of 28 infants with sepsis or probable infection (sensitivity 93%; specificity 82%; positive and negative predictive values 50 and 98%, respectively). Corresponding values for an elevated immature:total neutrophil ratio were 100, 75, 43 and 100%. Overall mortality with neutropenia was 15% and was higher with an infectious than a noninfectious etiology (39% vs. 11%, P < 0.001) despite early antibiotic therapy. The combination of a neutrophil count < or = 500/mm3 and scores > or = 3 or an elevated immature:total neutrophil ratio identified a poor prognostic group: 67% (8 of 12) and 70% (7 of 10) infants, respectively, with these findings died, 6 in the infected group. The hematologic scoring system or immature:total neutrophil ratio in combination with the degree of neutropenia provides valuable diagnostic and prognostic information which could be applied to identification of possible candidates for granulocyte transfusions or other experimental treatments.
前瞻性地检查了1000名新生儿的血液学特征，根据门罗等人的系统（《儿科学杂志》1979年；95:89 - 98）确定中性粒细胞减少症患儿（n = 170），并评估一种血液学评分系统（罗德韦尔等人，《儿科学杂志》1988年；112:761 - 7）作为脓毒症的筛查试验。中性粒细胞减少症更常见于非感染性而非感染性病因（83.5%对16.5%；P < 0.001）。在初次检测时，阳性筛查（评分≥3）在28名患有脓毒症或可能感染的婴儿中识别出26名（敏感性93%；特异性82%；阳性和阴性预测值分别为50%和98%）。未成熟与总中性粒细胞比值升高时的相应值分别为100%、75%、43%和100%。中性粒细胞减少症患儿的总体死亡率为15%，感染性病因的死亡率高于非感染性病因（39%对11%，P < 0.001），尽管进行了早期抗生素治疗。中性粒细胞计数≤500/mm³且评分≥3或未成熟与总中性粒细胞比值升高的组合确定了一个预后不良的组：分别有67%（12名中的8名）和70%（10名中的7名）有这些表现的婴儿死亡，感染组中有6名死亡。血液学评分系统或未成熟与总中性粒细胞比值结合中性粒细胞减少程度可提供有价值的诊断和预后信息，可应用于识别可能适合粒细胞输注或其他实验性治疗的候选者。
