新生儿侵袭性真菌感染27例临床特征

Clinical Features of Invasive Fungal Infection in 27 Neonates

目的分析NICU中新生儿侵袭性真菌感染的临床特点,为合理诊治提供依据。方法回顾性分析2009年11月-2011年11月本院NICU收治的27例侵袭性真菌感染患儿的临床资料,包括患儿一般资料、高危因素、临床症状、实验室检查、治疗及转归。结果 27例中早产儿25例(92.59%),其中极低出生体质量儿19例,超低出生体质量儿5例。患儿均接受广谱抗生素治疗和静脉营养,23例留置中心静脉导管(PICC),19例曾予机械通气,14例使用质子泵抑制剂。早期临床表现以呼吸暂停和喂养不耐受为主。实验室检查发现23例血小板进行性下降;24例1,3-β-D葡聚糖(BG)升高;7例脑脊液异常。26例血培养阳性均为念珠菌感染。7例中枢感染患儿头颅B超和MRI有异常表现。患儿均接受氟康唑、两性霉素B脂质体治疗,20例治愈,4例放弃治疗,3例死亡。结论新生儿侵袭性真菌感染多发于胎龄小于32周的极低出生体质量儿。反复呼吸暂停和喂养不耐受为早期主要临床表现,是早期识别和诊断的重要线索。动态监测血小板计数和BG是早期诊断的重要方法。氟康唑和两性霉素B脂质体对新生儿侵袭性真菌感染有良好疗效。规范广谱抗生素应用、加强PICC管理、严格掌握上机和撤机指征、尽早过渡至肠内营养是预防真菌感染的重要措施。

Objective To study the clinical features of invasive fungal infection in neonatal intensNe care unit（NICU） and to provide basis for rational diagnosis and therapy. Methods Twenty - seven neonates diagnosed as invasive fungal infection in NICU of Xinhua Hospital from Nov. 2009 to Nov. 2011 were retrospectively reviewed. Their perinatal data,risk factors, clinical manifestations,laboratory data, efficacy of anti - fungal therapy and prognosis were analyzed. Results There were 25 preterm infants of all patients, including 19 cases of very low birth weight infants and 5 cases of extremely low birth weight infants. All the cases received broad - spectrum antibiotics and parenteral nutri- tion,23 cases had pereutaneous inserted central catheters （PICC）, 19 cases had been on mechanical ventilation, 14 cases were recipient of H2 - blocks. They mainly presented with apnea and feeding intolerance at early stage of the disease. Their laboratory data were as follows ：23 infants developed thromboeytopenia, （1,3） -β- D- gluean （BG） was elevated in24 patients. Seven infants showed eerebrospinal fluid ab- normal. Blood culture showed candida in 26 cases. The cranial sonogram and MRI were abnormal in 7 neonates who had central nerve system infections. All cases received antifungal drug therapy such as flueonazol, amphotericin B liposome, or the two combinations. Twenty infants were cured ,4 infants were given up treatments by their parents ,3 infants died. Conclusions Preterm infants, especially very low birth weight neonates are susceptible to deep fungal infection in NICU. The main symptoms are feeding intolerance and apnea without other etiologies. Dy- namic observation of BG and platelets is helpful to diagnose invasive fungal infection early. The flueonazol and amphoteriein B liposome have effects on neonatal invasive fungal infections. Rational clinical use of broad - spectrum antibiotics, transition from parenteral nutrition to enteral nutrition as early as possible, standardized management of PlCC and learning the guideline of applying ventilator can reduce the rate of inva- sive fungal infection.