新生儿真菌性败血症临床特点分析

Clinical characteristics of neonatal fungal septicemia

目的探讨新生儿真菌性败血症的临床特点,以提高该疾病的诊治水平。方法选择2009—2011年我院新生儿重症监护病房收治的新生儿真菌性败血症病例,对患儿的一般状况、发病时间、首发症状、血培养结果、感染指标进行回顾性分析,比较治疗前与治疗中、治疗后血白细胞、血小板、C反应蛋白的变化情况。结果新生儿真菌性败血症的病原菌以白色念珠菌为主,发病日龄为生后5～29天,平均(11.5±9.9)天;频繁呼吸暂停、反应差、喂养不耐受、少动、发热是新生儿真菌性败血症的常见首发症状;多数患儿出现血小板减少、C反应蛋白增高,抗真菌治疗3天后多数患儿血小板可恢复正常,治疗1周后CRP可恢复正常,而WBC变化不明显,治疗前与治疗中、治疗后比较差异无统计学意义;应用氟康唑治疗新生儿念珠菌性败血症可取得满意疗效。结论新生儿真菌性败血症的临床表现缺乏特异性,对有高危因素的新生儿应高度警惕真菌感染的可能性,早期发现、及时治疗是治疗成功的关键。

Objective To study the clinical characteristics of neonatal fungal septicemia in order to improve diagnostic accuracy and treatment efficacy. Methods Retrospective analysis of the general condition, time of onset, first presenting symptom, blood culture results, infection indicators were performed in newborns with fungal sepsis who were admitted to our neonatal intensive care unit from January, 2009 to December, 2011, and changes of white blood cells, platelets, C-reactive protein were compared before, during and after treatment. Results Candida albicans was the major pathogen of neonatal fungal sepsis ; The onset time spanned 5 -29 days after birth, an average of （ 11.5 ± 9. 9 ） days; The most common presenting symptoms were frequent apnea, poor response, feeding intolerance, lack of movement, and fever; Thrombocytopenia and increased C-reactive protein level were seen in most patients, after 3 days of antifungal treatment, the platelets of the majority of the patients could rise to normal, CRP rise to normal after one week of antifungal treatment. The white blood cells did notchange significantly before, during or after treatment. Admiistration of fluconazole could achieve satisfactory results for neonatal candida septicemia. Conclusions Neonatal fungal septicemia showed no specific clinical manifestations, and newborns with risk factors should be highly alerted to the possibility of infection, early detection and prompt treatment were the key elements to successful treatment.