新生儿新型冠状病毒感染162例临床分析

Clinical characteristics of 162 neonates with SARS-CoV-2 infection

目的探讨新型冠状病毒(简称新冠病毒)感染新生儿的临床特点及不同临床分型之间的差异。方法回顾性分析广西壮族自治区妇幼保健院新生儿病房2022年12月11日至2023年1月10日确诊新冠病毒感染新生儿的病例资料,根据临床表现分为轻症组(包括无症状感染、轻型、普通型)和重症组(包括重型、危重型),比较不同组别的临床特征。结果共纳入162例新冠病毒感染患儿,男性91例(56.2%),早产儿27例(16.7%),低出生体重儿26例(16.0%)。发病日龄15(8,21)d,发病日龄>7 d 125例(77.2%),常见临床表现包括发热(79.0%)、咳嗽(59.3%)、鼻塞(42.6%),血常规异常70例(43.2%),以中性粒细胞减少多见。轻症组136例(84.0%),重症组26例(16.0%)。轻症组最常见的临床表现为发热(79.4%),重症组为发绀(92.3%)。与轻症组相比,重症组男性、早产儿、低出生体重儿、反应差比例更高,发热持续时间更长,差异有统计学意义(P<0.05)。两组血常规异常率差异无统计学意义(P>0.05)。60.6%(77/127)患儿胸部X线片提示肺炎。157例治愈或好转出院,住院时间5(3,6)d;5例自动出院。结论新生儿新冠病毒感染以轻型、普通型为主,临床症状轻,发热常见;少数为重型或危重型,发绀最常见;反应差、发热时间长者需警惕重型可能,尤其是男婴、早产儿及低出生体重儿。多数患儿近期预后良好。

Objective To study the clinical characteristics and differences between clinical subtypes of neonates with SARS-CoV-2 infection.Methods From December 11,2022 to January 10,2023,neonates with SARS-CoV-2 infection admitted to our hospital were retrospectively studied.The neonates were assigned into two groups according to the clinical classification:the mild group(including asymptomatic,mild and moderate disease)and the severe group(including severe and critical disease).The clinical characteristics were summarized and compared between the groups.Results Among 162 confirmed cases,91(56.2%)were male,27(16.7%)were preterm infants and 26(16.0%)were low birth weight infants(LBWIs).The average age of onset was 15(8,21)d with 125 cases(77.2%)had onset after 7 d of birth.The main clinical manifestations included fever(79.0%),cough(59.3%)and nasal congestion(42.6%).70 cases(43.2%)had abnormal complete blood count(CBC)with neutropenia most common.136 cases(84.0%)were in the mild group and 26 in the severe group.The severe group showed higher proportion of male,preterm and LBWIs than the mild group(P<0.05).The most common clinical manifestation was fever in the mild group and cyanosis in the severe group.Compared with the mild group,the severe group had higher incidence of poor response and longer duration of fever(P<0.05).No significant difference existed in CBC between the two groups(P>0.05).127 neonates received chest X-ray and 77(60.6%)showed pneumonia.157 neonates were discharged with improvement or full-recovery.The length of hospital stay was 5(3,6)d.5 patients were discharged refusing further treatment.Conclusions Most SARS-CoV-2 infections in neonates are mild and moderate types with mild symptoms and fever.A few are severe or critical types with cyanosis the most common symptom.Neonates with poor responses and prolonged fever need to be alerted to the possibility of severe disease,especially for male,preterm and LBWIs.Most neonates have a favorable prognosis.