Stoll B J, Gordon T, Korones S B, Shankaran S, Tyson J E, Bauer C R, Fanaroff A A, Lemons J A, Donovan E F, Oh W, Stevenson D K, Ehrenkranz R A, Papile L A, Verter J, Wright L L
Emory University, Atlanta, Georgia, USA.
J Pediatr. 1996 Jul;129(1):63-71. doi: 10.1016/s0022-3476(96)70191-9.
Late-onset sepsis (occurring after 3 days of age) is an important problem in very low birth weight (VLBW) infants. To determine the current incidence of late-onset sepsis, risk factors for disease, and the impact of late-onset sepsis on subsequent hospital course, we evaluated a cohort of 7861 VLBW (401 to 1500 gm) neonates admitted to the 12 National Institute of Child Health and Human Development (NICHD) Neonatal Research Network centers during a 32-month period (1991 to 1993).
The NICHD Neonatal Research Network maintains a prospectively collected registry of all VLBW neonates cared for at participating centers. Data from this registry were analyzed retrospectively.
Of 6911 infants who survived beyond 3 days, 1696 (25%) had one or more episodes of blood culture-proven sepsis. The vast majority of infection (73%) were caused by gram-positive organisms, with coagulase-negative staphylococci accounting for 55% of all infections. Rate of infection was inversely related to birth weight and gestational age. Complications of prematurity associated with an increased rate of infection included intubation, respiratory distress syndrome, prolonged ventilation, bronchopulmonary dysplasia, patent ductus arteriosus, severe intraventricular hemorrhage, and necrotizing enterocolitis. Among infants with bronchopulmonary dysplasia, those with late-onset sepsis had a significantly longer duration of mechanical ventilation (45 vs 33 days; p <0.01). Late-onset sepsis prolonged hospital stay: the mean number of days in the hospital for VLBW neonates with and without late-onset sepsis was 86 and 61 days, respectively (p <0.001). Even after adjustment for other complications of prematurity, including intraventricular hemorrhage, necrotizing enterocolitis, and bronchopulmonary dysplasia, infants with late-onset sepsis had a significantly longer hospitalization (p <0.001). Moreover, neonates in whom late-onset sepsis developed were significantly more likely to die than those who were uninfected (17% vs 7%; p <0.000 1), especially if they were infected with gram-negative organisms (40%) or fungi (28%). Deaths attributed to infection increased with increasing chronologic age. Whereas only 4% of deaths in the first 3 days of life were attributed to infection, 45% of deaths after 2 weeks were related to infection.
Late-onset sepsis is a frequent and important problem among VLBW preterm infants. Successful strategies to decrease late-onset sepsis should decrease VLBW mortality rates, shorten hospital stay, and reduce costs.
晚发型败血症（出生3天后发生）是极低出生体重（VLBW）婴儿的一个重要问题。为了确定晚发型败血症的当前发病率、疾病危险因素以及晚发型败血症对后续住院病程的影响，我们评估了在32个月期间（1991年至1993年）入住12个国家儿童健康与人类发展研究所（NICHD）新生儿研究网络中心的7861例VLBW（401至1500克）新生儿队列。
NICHD新生儿研究网络前瞻性收集了所有在参与中心接受治疗的VLBW新生儿的登记信息。对该登记信息中的数据进行回顾性分析。
在6911例存活超过3天的婴儿中，1696例（25%）发生了1次或多次血培养证实的败血症。绝大多数感染（73%）由革兰氏阳性菌引起，凝固酶阴性葡萄球菌占所有感染的55%。感染率与出生体重和胎龄呈负相关。与感染率增加相关的早产并发症包括插管、呼吸窘迫综合征、通气时间延长、支气管肺发育不良、动脉导管未闭、重度脑室内出血和坏死性小肠结肠炎。在患有支气管肺发育不良的婴儿中，发生晚发型败血症的婴儿机械通气时间明显更长（45天对33天；p<0.01）。晚发型败血症延长了住院时间：发生和未发生晚发型败血症的VLBW新生儿的平均住院天数分别为86天和61天（p<0.001）。即使在对包括脑室内出血、坏死性小肠结肠炎和支气管肺发育不良在内的其他早产并发症进行调整后，发生晚发型败血症的婴儿住院时间仍明显更长（p<0.001）。此外，发生晚发型败血症的新生儿死亡的可能性明显高于未感染的新生儿（17%对7%；p<0.0001），尤其是如果他们感染了革兰氏阴性菌（40%）或真菌（28%）。归因于感染的死亡随着实际年龄的增加而增加。出生后前3天仅有4%的死亡归因于感染，而2周后45%的死亡与感染有关。
晚发型败血症是VLBW早产儿中常见且重要的问题。降低晚发型败血症的成功策略应能降低VLBW死亡率、缩短住院时间并降低成本。
