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):72-80. doi: 10.1016/s0022-3476(96)70192-0.
Early-onset sepsis (occurring within 72 hours of birth) is included in the differential diagnosis of most very low birth weight (VLBW) neonates. To determine the current incidence of early-onset sepsis, risk factors for disease, and the impact of early-onset sepsis on subsequent hospital course, we studied a cohort of 7861 VLBW neonates (401 to 1500 gm) admitted to the 12 National Institute of Child Health and Human Development (NICHD) Neonatal Research Network centers during a 32-month period (1991-1993).
The NICHD Neonatal Research Network maintains a prospectively collected registry on all VLBW neonates born or cared for at participating centers. Data from this registry were analyzed retrospectively.
Blood culture-proven early-onset sepsis was uncommon, occurring in only 1.9% of VLBW neonates. Group B streptococcus was the most frequent pathogen associated with early-onset sepsis (31%), followed by Escherichia coli (16%) and Haemophilus influenzae (12%). Decreasing gestational age was associated with increased rates of infection. Antibiotic therapy for suspected sepsis is frequently initiated at birth in VLBW neonates. Almost half of the infants in this cohort were considered to have clinical sepsis and continued to receive antibiotics for 5 or more days, despite a negative blood culture result in 98% of cases. These findings underscore the difficulty of ruling out sepsis in the symptomatic immature neonate and the special concern for culture-negative clinical sepsis in the face of maternal antibiotic use. Neonates with early-onset sepsis were significantly more likely to have subsequent comorbidities, including severe intraventricular hemorrhage, patent ductus arteriosus, and prolonged assisted ventilation. Although 26% of VLBW neonates with early-onset sepsis died, only 4% of the 950 deaths that occurred in the first 72 hours of life were attributed to infection. For those infants discharged alive, early-onset sepsis was associated with a significantly prolonged hospital stay (86 vs 69 days; p <0.02).
Early-onset sepsis remains an important but uncommon problem among VLBW preterm infants. Improved diagnostic strategies are needed to enable the clinician to distinguish between the infected and the uninfected VLBW neonate with symptoms and to target continued antibiotic therapy to those who are truly infected.
早发型败血症（出生后72小时内发病）是大多数极低出生体重（VLBW）新生儿鉴别诊断的内容之一。为了确定早发型败血症的当前发病率、疾病危险因素以及早发型败血症对后续住院病程的影响，我们研究了在32个月期间（1991 - 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新生儿（体重401至1500克）。
NICHD新生儿研究网络前瞻性收集了所有在参与中心出生或接受护理的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。
血培养证实的早发型败血症并不常见，仅在1.9%的VLBW新生儿中发生。B族链球菌是与早发型败血症相关最常见的病原体（31%），其次是大肠杆菌（16%）和流感嗜血杆菌（12%）。孕周减小与感染率增加相关。VLBW新生儿出生时经常因疑似败血症而开始抗生素治疗。该队列中近一半的婴儿被认为患有临床败血症，尽管98%的病例血培养结果为阴性，但仍继续接受抗生素治疗5天或更长时间。这些发现凸显了在有症状的未成熟新生儿中排除败血症的困难，以及面对母亲使用抗生素时对培养阴性临床败血症的特别关注。患有早发型败血症的新生儿更有可能出现后续合并症，包括严重脑室内出血、动脉导管未闭和长时间辅助通气。虽然26%患有早发型败血症的VLBW新生儿死亡，但在出生后72小时内发生的950例死亡中，仅有4%归因于感染。对于那些存活出院的婴儿，早发型败血症与显著延长的住院时间相关（86天对69天；p<0.02）。
早发型败血症在VLBW早产儿中仍然是一个重要但不常见的问题。需要改进诊断策略，使临床医生能够区分有症状的感染和未感染的VLBW新生儿，并将持续的抗生素治疗针对真正感染的患儿。
