兒科學 新生兒敗血癥(英文)

Neonatology:

NeonatalSepticemiaLecturepoints

MorbidityandmortalityThecompromisedhostoftheneonatesinimmunologyPathogensforclinicalconsiderationClinicalmanifestationClinicalManagement2Incidence1%～10%,inlivebirth15-20%,inVLBW3Incidence‰‰GrossincidenceComparison:USanddevelopingcountries4NeonatalSepticemiaDeathrate:US5NeonatalSepticemiaDeathrate：developingcountriesLONS7.5%deathrate:9.8%~12%6ImmaturedevelopmentinbodydefenseImperfectfunctionLessexperienceofexposuretoenvironmentandpathogensAffectedbymaternalantibodiesImmunologicalfeatures

inneonates7Non-specificImmune:

PoorbarriersfunctionUndevelopedcomplementactivationcapacityRelativefewerneutrophil,ImmaturefunctionLowerILs,lowerlevelofcytokinesImmunologicalfeatures

inNeonates8SpecificImmune:

QuantitiesandqualityofIgG,A,MT,Bcell:quantities,qualityandtheirfunctionImmunologicalfeatures

inNeonates9PathogensDomestic:Staphylococcus:mostcommonlyseenEscherichiacoli,etc.G-bacillusUS:GBS:theleadingpathogenduring1970’sEscherichiacoli:theleadingpathogenduring1990’s10PathogenicChanges‰EONS:ChangesbyG+vs.G-Early1990’sLate1990’s11PathogenicChanges12RelevantfactorsofpathogenicchangesChangeofcolonizedpathogensinmaternalbirthcanalGBSScreeningPreventiveantibiotictherapyusedduringprepartumAmpicillineforthemotherwithGBSpositive:prepartumandIntro-partumGBSSepticemia

Efficacy：around70%（vs.controlP<0.0001）

13Pathogensbasedonthetypes

indevelopedcountryEONS：E.coliListeriamonocytogenes,PseudomonasMeningococcusEnterococcusandGBS

LONS：Coagulase-negativeStaphylococcusHaemophilusinfluenzabacillusOtherpathogens14Pathogensbasedonthetypes

indevelopedcountry15LONS(48hoursafterbirth)Mainly:G+Coagulase-negativeStaphylococcus

Partlyreported：Staphylococcusepidermidis,GBSandE.coli

EONS(within24-48hoursafterbirth) G+=G- G+：mainlyKlebsiellapneumoniaeandE.coli G-：EnterococcuscommonlyseenVEONS(within24hoursafterbirth)

Klebsiella、E.coli、EnterococcusPathogensbasedonthetypes

indevelopingcountry16EarlyonsetdominantsRelatedwiththematernalandtheintro-partumhighriskfactorsPathogensbasedonthetypes

indevelopingcountry17PathogensisolatedinChinamainisolates

frombloodculturebsedontheages:n=671/458/1849臨床兒科雜志：2002-2浙江大學附屬兒童醫(yī)院資料18PathogensisolatedinChina中華兒科雜志01-6；重慶兒科醫(yī)院資料Domesticdata：mainisolates:n=81519mainisolatesaccountforduringdifferentperiods:n=436臨床兒科雜志02-5：深圳市人民醫(yī)院兒科資料PathogensisolatedinChina20PathogensisolatedinChina臨床兒科雜志02-5：深圳市人民醫(yī)院兒科資料mainisolatesaccountforduringdifferentperiods:n=43621PathogensisolatedinChinamainisolatesaccountforduringdifferentperiods:n=606/475臨床兒科雜志：2002-2哈爾濱兒童醫(yī)院資料22ThepathofInfectionPath:Intrauterineinfection

Intro-partuminfectionPostdeliveringinfection

23Maternalintro-partumfever(OR=4.1CI=1.2-13.4)Repeatedvaginalexaminations(OR=2.9CI=1.1-8.0)AmongGBSSepsis,dystociaandmaternalfeveraccountfor49%Prolongedruptureofmembrane(PROM)≥18hour（79%）PrematuresandLBWLateronsetsepsis:PDA,LongtimeofIntravascularcatheter,variousofinvasiveprocedure,BPD

Riskfactorsofsepsisoccurrence24ClinicalmanifestationsGeneral：AnorexiaLessCryingFewerphysicalactivitiesLowertemperatureorfeverPoorweightinggainPersistentJaundiceFocal:OmphalitisSkininfectionBlepharitis(eyes)OtitismediaParonychia(nails)

25ClinicalmanifestationsToxic:ShockHepatosplenomegalySkindepositionpointDistensionAnemiaComplication:MeningitisPneumoniaPeritonitisUrinaryTractInfectionScleredemaDICToxicmyocarditis26LaboratoriesandinvestigationaidsPeripheralwholebloodtestBloodcultureOthers:CRP/PCTSmearofWBC:checkbacterialCSFUrineCXR27Clinical

ManagementAntibiotictherapySelectionbasedonthepathogenisolatedEarly,

Adequatedose,IVDuration:2weeksforG+,3weeksforG-.Longerdurationformeningitisandsevere28Supportivetherapy

FluidsupplementMaintenanceofelectrolyteandacid-basebalance:correctionofmetabolicacidosisEnoughenergysupplyKeep