新生儿RSV下呼吸道感染的临床特征

Study on clinical characteristics of RSV lower respiratory tract infection in neonatal patients

目的探讨新生儿呼吸道合胞病毒下呼吸道感染的临床特征。方法对2013年2月至2014年2月期间NICU收治的新生儿肺炎及毛细支气管炎患儿,用直接免疫荧光法检测痰液呼吸道合胞病毒（RSV）;对证实为RSV感染的临床资料进行回顾性总结分析。全部病儿除具有呼吸道症状外,肺部听诊可闻中小水泡音和/或胸片有斑片状阴影。结果检测证实为RSV感染者共30例,男性为多,22例（73.3%）。发病日龄为9～28 d,全部为晚期新生儿。出生时孕周35～42周（39.33±1.45周）,2例为早产儿。患儿均有咳嗽症状,19例肺部听诊有中小水泡音,出现发热或喘鸣音者各有5例（16.7%）;发生呼吸衰竭3例（10.0%）。血常规及CRP检测大部分正常。痰培养细菌阳性14例（43.3%）。胸片表现为斑片状阴影20例（66.7%）,其中有大片影2例（6.7%）;肺纹理粗重、模糊10例。经综合治疗全部病人均痊愈或好转出院。肺部啰音消失的平均病程为11.10±2.20 d;平均住院时间8.53±2.35 d。结论新生儿RSV下呼吸道感染的临床表现不典型,以咳嗽、鼻塞、气促及肺部中小水泡音多见,喘鸣音少见。抗生素应用的益处尚需评估。

Objective To explore the clinical characteristics of RSV lower respiratory tract infection in neonatal patients. Methods All newborns diagnosed as pneumonia and bronchiolitis admitted in neonatal intensive care unit of Capital Institute of Pediatrics during February 2013to February 2014 were included in this study. They had been detected for RSV in the way of direct immunoflurusence assay. The clinical manifestations,laboratory findings,complications,treatment and prognosis were retrospectively studied. Moist rales can be heard in the lung fields and /or patchy shadows can be found in chest X-ray films in all patients with respiratory symptoms. Results Thirty specimens of nasopharyngeal secretion were screened as positive for RSV antigen. Boys were more likely to be infected than girls. All these cases were late-term newborn infants. The age of onset was 9 to 28 days. Gestational weeks were 39. 33 ± 1. 45. There were two preterm infants（ 2. 7%）. The chief clinical manifestations were coughing（ 100. 0%）,followed by small and medium rales in the lung fields in 19 cases. Only 5 cases had fever and wheezing. There were 3 cases complicated with respiratory failure. The white blood cell count and serum level of CRP were normal in most of these cases. Chest X-ray films showed patchy shadows in 20 cases,including lobar shadows in 2 cases,and non-filtration changes in 10 cases. All of these patients recovered and discharged after comprehensive therapy. The moist rales were averagely disappeared on the day of 11. 10 ± 2. 20 in the clinical course. The average hospitalization days were 8. 53 ± 2. 35. Conclusion The clinical characteristics of RSV lower respiratory tract infection in neonates are atypical and mainly manifested by coughing,stuffy nose,shortness of breath,moist rales in lung fields but rarely wheezing.Whether antibiotics are effective for RSV infection is worthy to be discussed.