Fanaroff A A, Korones S B, Wright L L, Verter J, Poland R L, Bauer C R, Tyson J E, Philips J B, Edwards W, Lucey J F, Catz C S, Shankaran S, Oh W
Case Western Reserve University, Cleveland, OH, USA.
Pediatr Infect Dis J. 1998 Jul;17(7):593-8. doi: 10.1097/00006454-199807000-00004.
Septicemia is a major antecedent of morbidity and mortality in very low birth weight (501- to 1500-g) infants. Our purpose was to determine prospectively the incidence, clinical presentation, laboratory features, risk factors, morbidity and mortality associated with late onset septicemia in infants 501 to 1500 g.
Clinical data were prospectively collected for 2416 infants enrolled in a multicenter trial to determine the efficacy of intravenous immunoglobulin in preventing nosocomial infections. Septicemia was confirmed by positive blood culture in 395 symptomatic infants. Multivariate analyses of factors associated with septicemia were performed.
Sixteen percent of VLBW infants developed septicemia at a median age of 17 days. Factors associated with septicemia by logistic regression included male gender, lower gestational age and birth weight and decreased baseline serum IgG concentrations. Increasing apnea (55%), feeding intolerance, abdominal distension or guaiac-positive stools (43%), increased respiratory support (29%), lethargy and hypotonia (23%) were the dominant presenting features of septicemia. An abnormal white blood cell count (46%), unexplained metabolic acidosis (11%) and hyperglycemia (10%) were the most common laboratory indicators. Septicemic infants, compared with nonsepticemic infants, had significantly increased mortality (21% vs. 9%), longer hospital stay (98 vs. 58 days) and more serious morbidity, including severe intraventricular hemorrhage, bronchopulmonary dysplasia and increased ventilator days (P < 0.001).
Late onset septicemia is common in very low birth weight infants, and the rate is inversely proportional to gestational age and birth weight. Septicemia is more common in males and those with low initial serum IgG values. A set of clinical signs (apnea, bradycardia, etc.) and laboratory values (leukocytosis, immature white blood cells and neutropenia) increase the probability of late onset sepsis, but they have poor positive predictive value.
败血症是极低出生体重（501至1500克）婴儿发病和死亡的主要诱因。我们的目的是前瞻性地确定501至1500克婴儿晚发性败血症的发病率、临床表现、实验室特征、危险因素、发病率和死亡率。
前瞻性收集了参与一项多中心试验的2416名婴儿的临床数据，以确定静脉注射免疫球蛋白预防医院感染的疗效。395名有症状婴儿的血培养阳性确诊为败血症。对与败血症相关的因素进行了多变量分析。
16%的极低出生体重婴儿在中位年龄17天时发生败血症。逻辑回归分析显示，与败血症相关的因素包括男性、较低的胎龄和出生体重以及基线血清IgG浓度降低。呼吸暂停增加（55%）、喂养不耐受、腹胀或大便隐血阳性（43%）、呼吸支持增加（29%）、嗜睡和肌张力减退（23%）是败血症的主要表现特征。白细胞计数异常（46%）、不明原因的代谢性酸中毒（11%）和高血糖（10%）是最常见的实验室指标。与非败血症婴儿相比，败血症婴儿的死亡率显著增加（21%对9%），住院时间更长（98天对58天），发病率更高，包括严重的脑室内出血、支气管肺发育不良和机械通气天数增加（P<0.001）。
晚发性败血症在极低出生体重婴儿中很常见，其发生率与胎龄和出生体重成反比。败血症在男性和初始血清IgG值低的婴儿中更常见。一组临床体征（呼吸暂停、心动过缓等）和实验室值（白细胞增多、未成熟白细胞和中性粒细胞减少）增加了晚发性败血症的可能性，但它们的阳性预测价值较差。
