新生儿败血症的临床管理进展

俞元强; 陈平洋

doi:10.7499/j.issn.1008-8830.2309145

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中国当代儿科杂志 ›› 2024, Vol. 26 ›› Issue (5) : 518-522. DOI: 10.7499/j.issn.1008-8830.2309145

综述

新生儿败血症的临床管理进展

俞元强, 陈平洋

作者信息 +

Advances in clinical management of neonatal sepsis

YU Yuan-Qiang, CHEN Ping-Yang

Author information +

文章历史 +

摘要

新生儿败血症是新生儿各类合并症和不良预后的重要原因。国内外新生儿败血症的疾病负担仍较为严重。产时抗生素预防策略、早发型败血症风险计算器的应用和新生儿病房的质量改进等管理方案均有利于减轻新生儿败血症的疾病负担。该文就新生儿败血症的流行病学、危险因素和临床管理进展进行综述。

Abstract

Neonatal sepsis, as a significant cause of various complications and adverse outcomes in neonates, remains a serious health burden both domestically and internationally. Strategies such as antibiotic prophylaxis during delivery, the utilization of early-onset sepsis risk calculators, and quality improvement initiatives in neonatal wards are beneficial in alleviating the disease burden of neonatal sepsis. This paper provides a review of the epidemiology, risk factors, and recent advances in clinical management of neonatal sepsis.

导出引用

俞元强, 陈平洋. 新生儿败血症的临床管理进展[J]. 中国当代儿科杂志. 2024, 26(5): 518-522 https://doi.org/10.7499/j.issn.1008-8830.2309145

YU Yuan-Qiang, CHEN Ping-Yang. Advances in clinical management of neonatal sepsis[J]. Chinese Journal of Contemporary Pediatrics. 2024, 26(5): 518-522 https://doi.org/10.7499/j.issn.1008-8830.2309145

参考文献

1 Khan AM, Morris SK, Bhutta ZA. Neonatal and perinatal infections[J]. Pediatr Clin North Am, 2017, 64(4): 785-798. PMID: 28734510. DOI: 10.1016/j.pcl.2017.03.008.
2 Fleischmann-Struzek C, Goldfarb DM, Schlattmann P, et al. The global burden of paediatric and neonatal sepsis: a systematic review[J]. Lancet Respir Med, 2018, 6(3): 223-230. PMID: 29508706. DOI: 10.1016/S2213-2600(18)30063-8.
3 Tiskumara R, Fakharee SH, Liu CQ, et al. Neonatal infections in Asia[J]. Arch Dis Child Fetal Neonatal Ed, 2009, 94(2): F144-F148. PMID: 18805822. DOI: 10.1136/adc.2008.139865.
4 Chen XC, Yang YF, Wang R, et al. Epidemiology and microbiology of sepsis in the mainland of China in the first decade of the 21st century[J]. Int J Infect Dis, 2015, 31: 9-14. PMID: 25455799. DOI: 10.1016/j.ijid.2014.11.027.
5 Li JY, Chen SQ, Yan YY, et al. Identification and antimicrobial resistance of pathogens in neonatal septicemia in China: a meta-analysis[J]. Int J Infect Dis, 2018, 71: 89-93. PMID: 29689386. DOI: 10.1016/j.ijid.2018.04.794.
6 Dong Y, Speer CP. Late-onset neonatal sepsis: recent developments[J]. Arch Dis Child Fetal Neonatal Ed, 2015, 100(3): F257-F263. PMID: 25425653. PMCID: PMC4413803. DOI: 10.1136/archdischild-2014-306213.
7 Cailes B, Kortsalioudaki C, Buttery J, et al. Epidemiology of UK neonatal infections: the neonIN infection surveillance network[J]. Arch Dis Child Fetal Neonatal Ed, 2018, 103(6): F547-F553. PMID: 29208666. DOI: 10.1136/archdischild-2017-313203.
8 Born S, Dame C, Matth?us-Kr?mer C, et al. Epidemiology of sepsis among children and neonates in Germany: results from an observational study based on nationwide diagnosis-related groups data between 2010 and 2016[J]. Crit Care Med, 2021, 49(7): 1049-1057. PMID: 33729720. DOI: 10.1097/CCM.0000000000004919.
9 Schrag SJ, Farley MM, Petit S, et al. Epidemiology of invasive early-onset neonatal sepsis, 2005 to 2014[J]. Pediatrics, 2016, 138(6): e20162013. PMID: 27940705. DOI: 10.1542/peds.2016-2013.
10 Singh T, Barnes EH, Isaacs D, et al. Early-onset neonatal infections in Australia and New Zealand, 2002-2012[J]. Arch Dis Child Fetal Neonatal Ed, 2019, 104(3): F248-F252. PMID: 29588295. DOI: 10.1136/archdischild-2017-314671.
11 Sgro M, Shah PS, Campbell D, et al. Early-onset neonatal sepsis: rate and organism pattern between 2003 and 2008[J]. J Perinatol, 2011, 31(12): 794-798. PMID: 21527901. DOI: 10.1038/jp.2011.40.
12 Al-Taiar A, Hammoud MS, Liu C, et al. Neonatal infections in China, Malaysia and Thailand[J]. Arch Dis Child Fetal Neonatal Ed, 2013, 98(3): F249-F255. PMID: 22942104. DOI: 10.1136/archdischild-2012-301767.
13 Gao K, Fu J, Guan X, et al. Incidence, bacterial profiles, and antimicrobial resistance of culture-proven neonatal sepsis in South China[J]. Infect Drug Resist, 2019, 12: 3797-3805. PMID: 31819560. PMCID: PMC6899077. DOI: 10.2147/IDR.S223597.
14 Lu Q, Zhou M, Tu Y, et al. Pathogen and antimicrobial resistance profiles of culture-proven neonatal sepsis in Southwest China, 1990-2014[J]. J Paediatr Child Health, 2016, 52(10): 939-943. PMID: 27500793. DOI: 10.1111/jpc.13278.
15 Puopolo KM, Draper D, Wi S, et al. Estimating the probability of neonatal early-onset infection on the basis of maternal risk factors[J]. Pediatrics, 2011, 128(5): e1155-e1163. PMID: 22025590. PMCID: PMC3208962. DOI: 10.1542/peds.2010-3464.
16 Yu YQ, He XR, Wan LJ, et al. Etiology, antimicrobial resistance, and risk factors of neonatal sepsis in China: a systematic review and meta-analysis from data of 30 years[J]. J Matern Fetal Neonatal Med, 2022, 35(25): 7541-7550. PMID: 34470123. DOI: 10.1080/14767058.2021.1951217.
17 Chan GJ, Lee AC, Baqui AH, et al. Risk of early-onset neonatal infection with maternal infection or colonization: a global systematic review and meta-analysis[J]. PLoS Med, 2013, 10(8): e1001502. PMID: 23976885. PMCID: PMC3747995. DOI: 10.1371/journal.pmed.1001502.
18 Villamor-Martinez E, Lubach GA, Rahim OM, et al. Association of histological and clinical chorioamnionitis with neonatal sepsis among preterm infants: a systematic review, meta-analysis, and meta-regression[J]. Front Immunol, 2020, 11: 972. PMID: 32582153. PMCID: PMC7289970. DOI: 10.3389/fimmu.2020.00972.
19 Wortham JM, Hansen NI, Schrag SJ, et al. Chorioamnionitis and culture-confirmed, early-onset neonatal infections[J]. Pediatrics, 2016, 137(1): e20152323. PMID: 26719293. PMCID: PMC4702021. DOI: 10.1542/peds.2015-2323.
20 Strunk T, Doherty D, Jacques A, et al. Histologic chorioamnionitis is associated with reduced risk of late-onset sepsis in preterm infants[J]. Pediatrics, 2012, 129(1): e134-e141. PMID: 22157134. DOI: 10.1542/peds.2010-3493.
21 Puopolo KM, Mukhopadhyay S, Hansen NI, et al. Identification of extremely premature infants at low risk for early-onset sepsis[J]. Pediatrics, 2017, 140(5): e20170925. PMID: 28982710. PMCID: PMC5654397. DOI: 10.1542/peds.2017-0925.
22 Kung YH, Hsieh YF, Weng YH, et al. Risk factors of late-onset neonatal sepsis in Taiwan: a matched case-control study[J]. J Microbiol Immunol Infect, 2016, 49(3): 430-435. PMID: 24274960. DOI: 10.1016/j.jmii.2013.10.001.
23 修文龙, 杨长仪, 赖淑华, 等. 极低出生体重儿晚发型败血症发生情况及其危险因素[J]. 中华围产医学杂志, 2020, 23(5): 338-344. DOI: 10.3760/cma.j.cn113903-20190912-00552.
24 Hei MY, Zhang XC, Gao XY, et al. Catheter-related infection and pathogens of umbilical venous catheterization in a neonatal intensive care unit in China[J]. Am J Perinatol, 2012, 29(2): 107-114. PMID: 22131046. DOI: 10.1055/s-0031-1295650.
25 Shalabi M, Adel M, Yoon E, et al. Risk of infection using peripherally inserted central and umbilical catheters in preterm neonates[J]. Pediatrics, 2015, 136(6): 1073-1079. PMID: 26574592. DOI: 10.1542/peds.2015-2710.
26 Wu IH, Tsai MH, Lai MY, et al. Incidence, clinical features, and implications on outcomes of neonatal late-onset sepsis with concurrent infectious focus[J]. BMC Infect Dis, 2017, 17(1): 465. PMID: 28673280. PMCID: PMC5496375. DOI: 10.1186/s12879-017-2574-7.
27 Puopolo KM, Lynfield R, Cummings JJ, et al. Management of infants at risk for group B streptococcal disease[J]. Pediatrics, 2019, 144(2): e20191881. PMID: 31285392. DOI: 10.1542/peds.2019-1881.
28 郭九叶, 桑田, 王颖. 新生儿早发型B族链球菌病的预防[J]. 中华新生儿科杂志, 2020, 35(3): 239-240. DOI: 10.3760/cma.j.issn.2096-2932.2020.03.021.
29 Stoll BJ, Hansen NI, Sánchez PJ, et al. Early onset neonatal sepsis: the burden of group B streptococcal and E. coli disease continues[J]. Pediatrics, 2011, 127(5): 817-826. PMID: 21518717. PMCID: PMC3081183. DOI: 10.1542/peds.2010-2217.
30 Stoll BJ, Puopolo KM, Hansen NI, et al. Early-onset neonatal sepsis 2015 to 2017, the rise of Escherichia coli, and the need for novel prevention strategies[J]. JAMA Pediatr, 2020, 174(7): e200593. PMID: 32364598. PMCID: PMC7199167. DOI: 10.1001/jamapediatrics.2020.0593.
31 Nanduri SA, Petit S, Smelser C, et al. Epidemiology of invasive early-onset and late-onset group B streptococcal disease in the United States, 2006 to 2015: multistate laboratory and population-based surveillance[J]. JAMA Pediatr, 2019, 173(3): 224-233. PMID: 30640366. PMCID: PMC6439883. DOI: 10.1001/jamapediatrics.2018.4826.
32 Huang J, Lin XZ, Zhu Y, et al. Epidemiology of group B streptococcal infection in pregnant women and diseased infants in the mainland of China[J]. Pediatr Neonatol, 2019, 60(5): 487-495. PMID: 31445795. DOI: 10.1016/j.pedneo.2019.07.001.
33 彭周杰, 包蕾. 产时抗菌药物预防治疗B族链球菌感染对早发型新生儿败血症发生率及病原菌分布的影响[J]. 中国当代儿科杂志, 2022, 24(1): 49-53. PMID: 35177175. PMCID: PMC8802383. DOI: 10.7499/j.issn.1008-8830.2109031.
34 何笑笑, 朱敏丽, 杨祖钦, 等. 新生儿早发型B族链球菌感染危险因素分析[J]. 中华新生儿科杂志, 2020, 35(3): 197-201. DOI: 10.3760/cma.j.issn.2096-2932.2020.03.008.
35 中华医学会围产医学分会, 中华医学会妇产科学分会产科学组. 预防围产期B族链球菌病（中国）专家共识[J]. 中华围产医学杂志, 2021, 24(8): 561-566. DOI: 10.3760/cma.j.cn113903-20210716-00638.
36 中国妇幼保健协会新生儿保健专业委员会, 中国医师协会新生儿科医师分会. 母婴同室早发感染高危新生儿临床管理专家共识[J]. 中华围产医学杂志, 2021, 24(8): 567-575. DOI: 10.3760/cma.j.cn113903-20210310-00202.
37 Escobar GJ, Puopolo KM, Wi S, et al. Stratification of risk of early-onset sepsis in newborns ≥34 weeks' gestation[J]. Pediatrics, 2014, 133(1): 30-36. PMID: 24366992. PMCID: PMC4079292. DOI: 10.1542/peds.2013-1689.
38 Benitz WE, Achten NB. Technical assessment of the neonatal early-onset sepsis risk calculator[J]. Lancet Infect Dis, 2021, 21(5): e134-e140. PMID: 33129425. DOI: 10.1016/S1473-3099(20)30490-4.
39 Puopolo KM, Benitz WE, Zaoutis TE, et al. Management of neonates born at ≥35 0/7 weeks' gestation with suspected or proven early-onset bacterial sepsis[J]. Pediatrics, 2018, 142(6): e20182894. PMID: 30455342. DOI: 10.1542/peds.2018-2894.
40 He Y, Chen J, Liu Z, et al. Efficacy and safety of applying a neonatal early-onset sepsis risk calculator in China[J]. J Paediatr Child Health, 2020, 56(2): 237-243. PMID: 31328848. DOI: 10.1111/jpc.14572.
41 杜秀丽, 蒋思远, 曹云. 新生儿早发型败血症风险计算器在新生儿早发型败血症风险评估中的作用[J]. 中华围产医学杂志, 2021, 24(9): 709-713. DOI: 10.3760/cma.j.cn113903-20210117-00046.
42 Kuzniewicz MW, Puopolo KM, Fischer A, et al. A quantitative, risk-based approach to the management of neonatal early-onset sepsis[J]. JAMA Pediatr, 2017, 171(4): 365-371. PMID: 28241253. DOI: 10.1001/jamapediatrics.2016.4678.
43 邵诗琪, 张馨尹, 冯昆, 等. 败血症风险计算器指导下疑诊早发型败血症新生儿的抗生素管理[J]. 中国当代儿科杂志, 2021, 23(6): 582-587. PMID: 34130779. PMCID: PMC8213997. DOI: 10.7499/j.issn.1008-8830.2101167.
44 Achten NB, Klingenberg C, Benitz WE, et al. Association of use of the neonatal early-onset sepsis calculator with reduction in antibiotic therapy and safety: a systematic review and meta-analysis[J]. JAMA Pediatr, 2019, 173(11): 1032-1040. PMID: 31479103. PMCID: PMC6724419. DOI: 10.1001/jamapediatrics.2019.2825.
45 Carola D, Vasconcellos M, Sloane A, et al. Utility of early-onset sepsis risk calculator for neonates born to mothers with chorioamnionitis[J]. J Pediatr, 2018, 195: 48-52.e1. PMID: 29275925. DOI: 10.1016/j.jpeds.2017.11.045.
46 Achten NB, Visser DH, Tromp E, et al. Early onset sepsis calculator implementation is associated with reduced healthcare utilization and financial costs in late preterm and term newborns[J]. Eur J Pediatr, 2020, 179(5): 727-734. PMID: 31897840. PMCID: PMC7160215. DOI: 10.1007/s00431-019-03510-9.
47 Stipelman CH, Smith ER, Diaz-Ochu M, et al. Early-onset sepsis risk calculator integration into an electronic health record in the nursery[J]. Pediatrics, 2019, 144(2): e20183464. PMID: 31278210. PMCID: PMC10483882. DOI: 10.1542/peds.2018-3464.
48 van Hasselt TJ, McDermott H, Surana P, et al. Impact of neonatal sepsis calculator in West Midlands (UK)[J]. Arch Dis Child Fetal Neonatal Ed, 2021, 106(5): 568-569. PMID: 33293276. DOI: 10.1136/archdischild-2020-320862.
49 Strunk T, Buchiboyina A, Sharp M, et al. Implementation of the neonatal sepsis calculator in an Australian tertiary perinatal centre[J]. Neonatology, 2018, 113(4): 379-382. PMID: 29514161. DOI: 10.1159/000487298.
50 Mukherjee A, Davidson L, Anguvaa L, et al. Nice neonatal early onset sepsis guidance: greater consistency, but more investigations, and greater length of stay[J]. Arch Dis Child Fetal Neonatal Ed, 2015, 100(3): F248-F249. PMID: 25079114. DOI: 10.1136/archdischild-2014-306349.
51 Goel N, Shrestha S, Smith R, et al. Screening for early onset neonatal sepsis: nice guidance-based practice versus projected application of the Kaiser Permanente sepsis risk calculator in the UK population[J]. Arch Dis Child Fetal Neonatal Ed, 2020, 105(2): 118-122. PMID: 31296696. DOI: 10.1136/archdischild-2018-316777.
52 Morris R, Jones S, Banerjee S, et al. Comparison of the management recommendations of the Kaiser Permanente neonatal early-onset sepsis risk calculator (SRC) with nice guideline CG149 in infants ≥34 weeks' gestation who developed early-onset sepsis[J]. Arch Dis Child Fetal Neonatal Ed, 2020, 105(6): 581-586. PMID: 32170032. DOI: 10.1136/archdischild-2019-317165.
53 Bowen JR, Callander I, Richards R, et al. Decreasing infection in neonatal intensive care units through quality improvement[J]. Arch Dis Child Fetal Neonatal Ed, 2017, 102(1): F51-F57. PMID: 27142638. DOI: 10.1136/archdischild-2015-310165.
54 Zhou Q, Lee SK, Hu XJ, et al. Successful reduction in central line-associated bloodstream infections in a Chinese neonatal intensive care unit[J]. Am J Infect Control, 2015, 43(3): 275-279. PMID: 25728154. DOI: 10.1016/j.ajic.2014.12.001.
55 Wang W, Zhao C, Ji Q, et al. Prevention of peripherally inserted central line-associated blood stream infections in very low-birth-weight infants by using a central line bundle guideline with a standard checklist: a case control study[J]. BMC Pediatr, 2015, 15: 69. PMID: 26084807. PMCID: PMC4470111. DOI: 10.1186/s12887-015-0383-y.
56 Payne V, Hall M, Prieto J, et al. Care bundles to reduce central line-associated bloodstream infections in the neonatal unit: a systematic review and meta-analysis[J]. Arch Dis Child Fetal Neonatal Ed, 2018, 103(5): F422-F429. PMID: 29175985. DOI: 10.1136/archdischild-2017-313362.
57 中国新生儿重症监护室协作性质量改进研究协作组. 基于证据的质量改进方法降低中国新生儿重症监护室院内感染发生率的整群随机对照试验方案[J]. 中国循证儿科杂志, 2018, 13(1): 64-69. DOI: 10.3969/j.issn.1673-5501.2018.01.010.
58 许淑静, 余增渊, 曹云, 等. 基于证据的集束化改进措施在预防早产儿晚发败血症中的应用[J]. 中华临床感染病杂志, 2019, 12(6): 467-473. DOI: 10.3760/cma.j.issn.1674-2397.2019.06.006.
59 Zaka N, Alexander EC, Manikam L, et al. Quality improvement initiatives for hospitalised small and sick newborns in low- and middle-income countries: a systematic review[J]. Implement Sci, 2018, 13(1): 20. PMID: 29370845. PMCID: PMC5784730. DOI: 10.1186/s13012-018-0712-2.