低危SBI发热新生儿快速筛查指标的初步研究

Quick criteria for identifying of febrile neonates with low risk for serious bacterial infection

目的探索一种简单、有效的对新生儿非严重细菌感染(serious bacterial infection,SBI)性发热性疾病的早期鉴别方法,为减少抗生素使用提供有效依据。方法选取2006年1月到2007年6月入住我科的发热新生儿为研究对象。病人情况完全符合预先确定的指标体系者视为SBI低危组,其他则归为SBI高危组,比较两组SBI发病率和两组病例入院后发热持续时间并推断该指标体系对SBI的阴性预测值(negative predictive value,NPV)。结果在153例发热新生儿中,SBI低危组共58例,仅2(3.45%)例最终被确诊为SBI;相对于SBI高危组95例中有51(53.68%)例确诊为SBI,其差异有统计学意义(P<0.001)。该指标体系对SBI的阴性预测值为96.55%(其95%可信区间为91.86%-100%)。结论该指标体系可简单、快速、可靠排除发热新生儿为SBI,具有一定临床指导意义。

Objective： To examine the possible usefulness of simple and quick criteria for identifying febrile neonates with low risk for serious bacterial infection （SBI） and thus provide reliable proof for a decreased use of antibiotics. Methods： All febrile neonates who were admitted between January 2006 and June 2007 to the Newborn Infant Department were included in the study. Patients who met all the criteria which had been already set were considered to have low risk for SBI . Others were considered to have high risk for SBI. The incidence of having SBI and the duration of high fever after staying in hospital between the two groups mentioned above were compared to predict the negative predictive value of these criteria. Results： Complete data were available for 153 neonates. The overall incidence of SBI was 2 in 58 （3.45%） neonates who have low risk for SBI compared with 51 in 95 （53.68%） in the neonates who have high risk for SBI （ P 〈0. 001 ）. The negative predictive value for SBI of the combination of the low -risk criteria was 96.55% （95% confidence interval 91.86% - 100% ）. Conclusions： Fulfilment of the criteria for low risk might be a reliable and useful tool for excluding SBI in febrile neonates.