新生儿重症监护病房住院患儿合并流感病毒感染11例临床分析

Clinical analysis of 11 cases of neonates with influenza virus infection in the neonatal intensive care unit

目的分析新生儿重症监护病房(NICU)住院患儿合并流感病毒感染的临床特征、检查检验结果、治疗及预后。方法收集2018年1月至2020年12月在南部战区总医院NICU住院、且检验出合并流感病毒感染的新生儿病例资料, 对患儿临床症状、检查检验结果、治疗方法及病情变化情况进行回顾性分析。结果共11例NICU住院患儿合并流感病毒感染, 其中甲型流感2例、乙型流感9例;10例(90.9%)患儿出现呼吸道症状(需升级氧疗8例、并发肺炎7例、呼吸困难4例、呼吸暂停2例), 7例体温波动(发热6例、低体温1例), 5例有循环系统症状, 5例有消化系统症状, 3例有泌尿系统症状, 8例合并其他全身症状(精神反应一般或反应差3例、黄疸加重3例、体质量下降3例、血糖增高2例、水肿和硬肿1例)。治疗上, 采用静注人丙种球蛋白免疫治疗10例, 血浆免疫支持治疗2例, 帕拉米韦抗病毒治疗1例;8例升级氧疗, 其中上调无创呼吸机参数或模式4例、上调鼻导管给氧浓度2例、无创改为有创呼吸机辅助通气1例、鼻导管给氧改为无创呼吸机辅助通气1例;4例患儿接受抗休克和/或增强心肌收缩力治疗。结论 NICU住院新生儿合并流感病毒感染以呼吸系统症状、发热为主要表现, 并发肺炎比例高, 多系统同时受累时常导致严重疾病状态, 需采取综合支持治疗;应关注相关症状, 尽早检测流感病毒, 明确诊断、及时隔离是防止暴发的关键。

Objective To analyze the clinical characteristics,examination results,treatment and prognosis of neonates with influenza virus infection in the neonatal intensive care unit(NICU).Methods Clinical data of neonates with influenza virus infection who were hospitalized in the NICU of the General Hospital of Southern Theater Command of Chinese People′s Liberation Army from January 2018 to December 2020 were retrospectively analyzed.Results A total of 11 hospitalized neonates with influenza virus infection in the NICU were recruited,including 2 cases of influenza A and 9 cases of influenza B.Ten cases(90.9%)had respiratory symptoms,and among them,there were 8 cases with increased oxygen demand,7 cases with complicated pneumonia,4 cases with dyspnea,and 2 cases with apnea.Seven cases showed abnormal body temperature,including 6 cases of fever,and 1 case of hypothermia.Five cases had circulatory system symptoms.Digestive system symptoms and urinary system symptoms were detected in 5 cases and 3 cases,respectively.Eight cases complicated with systemic symptoms,including 3 cases of poor mental response,3 cases of worsening jaundice,3 cases of weight loss,2 cases of hyperglycemia,1 case of edema and sclerosis.Ten cases were treated with gamma globulin immunotherapy,2 cases were treated with plasma immune support,and 1 case was treated with Peramivir antiviral.Eight cases were treated with increased oxygen therapy,among which non-invasive ventilator parameters or modes increased in 4 cases,and nasal cannula oxygen concentration increased in 2 cases.The change of noninvasive-assisted ventilation to invasive-assisted ventilation occurred in 1 case,and 1 case developed the change of nasal cannula to noninvasive-assisted ventilation.Four neonates received anti-shock and(or)myocardial contractility therapy.Conclusions Neonates with influenza virus infection in the NICU are mainly manifested as respiratory symptoms and fever,and the incidence of complicated pneumonia is high.Multiple systems may be involved at the same time,often leading to severe disease status.Comprehensive supportive treatment is necessary.Neonatologists should pay attention to these symptoms,and early detection of influenza virus and timely isolation are the key methods to prevent influenza outbreaks in NICU.