早产儿蜡样芽孢杆菌败血症十例临床分析

Clinical analysis of 10 cases of Bacillus cereus sepsis in premature infants

目的探讨早产儿蜡样芽孢杆菌败血症的临床特征及诊疗情况。方法选择2011年2月至2021年2月郑州大学第三附属医院新生儿科收治的早产儿蜡样芽孢杆菌败血症患儿进行回顾性分析,分析其临床特征和治疗结局。结果共收治10例蜡样芽孢杆菌败血症早产儿,男女各5例,胎龄27^(+2)~35^(+2)周,出生体重940~2430 g,起病日龄7~35 d,10例起病时均有反应差、频繁呼吸暂停,肤色发灰8例,发热7例,感染性休克7例,惊厥5例,腹胀4例;合并化脓性脑膜炎7例,合并坏死性小肠结肠炎3例。9例病初有血白细胞和血小板明显下降,C反应蛋白及降钙素原明显升高;7例化脓性脑膜炎中5例合并多发脑软化。死亡4例,存活6例中治愈3例,遗留严重神经系统后遗症3例。结论早产儿蜡样芽孢杆菌败血症起病急骤,进展迅速,易发生化脓性脑膜炎,病死率高,即使存活,遗留严重神经系统后遗症几率大。

Objective To study the clinical features,diagnosis and treatment of Bacillus cereus sepsis in premature infants.Methods From February 2011 to February 2021,10 cases of Bacillus cereus sepsis in premature infants admitted to the Department of Neonatology of our hospital were retrospectively analyzed.Results The 10 cases of premature infants with Bacillus cereus sepsis included 5 males and 5 females,with gestational age 27^(+2)~35^(+2) weeks,birth weight 940~2430 g and the age of onset 7~35 days.At the beginning,all the infants showed lethargy and recurrent apnea as the onset symptoms.8 cases had gray color skin,7 cases had fever,7 cases experienced septic shock,5 cases had neonatal seizures and 4 cases showed abdominal distension.7 cases were complicated with purulent meningitis and 3 cases with necrotizing enterocolitis.9 cases had significantly decreased white blood cells and platelets and significantly increased C-reactive protein and procalcitonin at the onset.Among the 7 cases of purulent meningitis,5 cases had multiple encephalomalacia.During follow-up of all the infants,4 cases died,3 cases cured and 3 cases survived with severe neurological sequelae.Conclusions Bacillus cereus sepsis is a serious infectious disease for premature infants with acute onset,rapid progress and high mortality.Complication of purulent meningitis and serious neurological sequelae are common.