在妊娠29周之前出生的婴儿中,晚发性细菌性败血症后的神经发育结果
Smita Roychoudhury1, Abhay Lodha2,3, Anne Synnes4
1Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada.
American journal of perinatology
|January 29, 2026
概括
在早产儿中晚期发作的败血症会增加死亡率和神经发育障碍的风险. 格拉姆阴性和混合性败血症对极度早产婴儿的不良结果构成最高风险.
科学领域:
- 新生儿科学 新生儿科学
- 儿科神经学 儿科神经学
- 传染性疾病 传染性疾病
背景情况:
- 晚发性败血症 (LOS) 显著影响早产婴儿的死亡率和长期结果.
- 了解与不同细菌病原体相关的特定风险对于有针对性的干预至关重要.
- 关于极度早产婴儿中由致病细菌分层的神经发育 (ND) 结果的数据有限.
研究的目的:
- 为了评估神经发育结果在18-24个月校正年龄的早产婴儿 (<29周怀孕) 与LOS.
- 根据导致LOS的细菌病原体类型 (格拉姆阳性,格拉姆阴性,混合) 进行ND结局的比较.
- 确定与死亡或神经发育障碍风险增加相关的特定细菌类型.
主要方法:
- 在加拿大NICU (2010-2017) 怀孕29周以下的非异常婴儿的回顾性队列研究.
- 包括经过加拿大新生儿随访网络纠正年龄的18-24个月的ND评估的婴儿.
- 通过调整的分析,将LOS (根据病原体类型分类) 和没有败血症的婴儿之间的ND结局 (死亡或神经发育障碍) 进行比较.
主要成果:
- 在3640名婴儿中,823名 (22.6%) 患有LOS. 格拉姆阳性败血症是最常见的 (69.1%),其次是格拉姆阴性 (20.9%) 和混合 (10%).
- 患有LOS的婴儿出生时体重,妊娠年龄显著降低,新生儿发病率更高.
- 格拉姆阴性败血症 (aOR=1.80) 和混合败血症 (aOR=2.38) 与没有败血症相比,与较高的死亡或神经发育障碍相关.
结论:
- 晚期出现的细菌性败血症,特别是格兰氏阴性和混合型,会增加极度早产婴儿死亡或神经发育障碍的风险.
- 这些发现凸显了在这个脆弱人群中早期识别和管理LOS的关键需求.
- 病原体特异性风险强调了定制治疗策略的重要性,以改善长期神经发育结果.
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