新生儿呼吸道合胞病毒下呼吸道感染临床分析及随访

Clinical analysis and follow-up of neonatal lower respiratory tract infection with respiratory syncytial virus

目的探讨新生儿呼吸道合胞病毒（RSV）下呼吸道感染的临床特点，及其与患儿出院后反复咳喘的关系。方法选取2008年5月至2013年5月于北京新世纪儿童医院诊断为RSV下呼吸道感染的新生儿，对患儿临床资料及出院后随访结果进行分析。结果共纳入41例RSV下呼吸道感染新生儿。41例均有咳嗽症状，38例（92．7％）有呛奶，13例（31．7％）有发热，27例（65．9％）患儿肺部有喘鸣音；12例（29．3％）合并细菌感染，最常见为金黄色葡萄球菌（50．0％，6／12例）。RSV并细菌感染组患儿（12例）发热比例高于单纯RSV感染组（29例），差异有统计学意义（χ2=6．034，P〈0．05），而白细胞总数及胸片有片影2组问差异无统计学意义（χ2=0．859、2．064，P=0．485、0．202）。有特应性家族史的患儿与无特应性家族史的患儿比较，RSV下呼吸道感染时更易出现喘息（88．2％比57．1％，χ2=4．871，P〈0．05）。出院后随访，患儿出现反复咳嗽和／或喘息组与无反复咳嗽和／或喘息组比较，前者有特应性家族史者比例更高（71．4％比26．3％，χ2=6．388，P〈0．05）。结论新生儿RSV下呼吸道感染多表现为咳嗽、呛奶、部分患儿肺部查体可无喘鸣音，仅有湿哕音。新生儿RSV下呼吸道感染易合并细菌感染。有特应性家族史患儿RSV下呼吸道感染时更易出现喘息，RSV感染后更易出现反复咳喘。

Objective To investigate the clinical features of neonatal lower respiratory tract infection （LRTI） with respiratory syneytial virus（ RSV）, and to explore the relationship between clinical features and recurrent cough or wheezing after discharge. Methods From May 2008 to May 2013, the data of 41 neonates diagnosed as LRTI with RSV infection in New Century International Children＇s Hospital were analyzed retrospectively. The clinical features and fol- low-up resuhs were observed. Results All the neonates had cough,92.7% （38/41 cases） had choking,85.4% （35/ 41 cases） had runny nose and nasal obstruction,31.7% （13/41 cases） had fever,65.9% （27/41 cases） had whee- zing sound during physical examination,29.3% （ 12/41 cases） of the neonates were accompanied with bacterial infec- tion（ n = 29 ） , in which 50.0% （ 6/12 cases ） were infected by staphylococcus aureus. Compared to the neonates only with RSV infection, the proportion of fever was higher in those with RSV combined with bacterial infection （n = 12 ） （χ2 = 6. 034 ,P 〈 0. 05 ）, and there were no statistical differences between the neonates with or without bacterial infec- tion in white blood cell count and with or without shadow in chest X-ray（χ2 =0. 859,2. 064 ,P =0.485,0. 202）. Com- pared with the neonates without family history of atopy, the neonates with the family history of atopy were more likely to get wheezing （88.2% vs 57.1% ,χ2 = 4.871, P 〈 0.05 ）during primary infection. During the follow-up, there was higher proportion of children with family history of atopy in the group with subsequent recurrent cough and/or wheezing than in the group without subsequent recurrent cough and/or wheezing （71.4% vs 26.3% , χ2 = 6. 388, P 〈 0.05 ）. Conclu- sions Cough, choking are most common symptoms in neonatal LRTI with RSV,and there is no wheezing sound during phy-sical examination in some neonates. LRTI with RSV is likely combined with bacterial infection. Wheezing is more common in the neonates with family history of atopy. The RSV LTR! neonates with family history of atopy incline to get subsequent recurrent cough or wheeze after discharge.