早产儿先天性结核1例

Congenital tuberculosis in a premature infant: a case report

本文报道了1例早产儿先天性结核的诊断及治疗过程。患儿系胎龄29+1周阴道娩出,生后立即收入武汉大学中南医院新生儿重症监护室(neonatal intensive care unit,NICU)负压隔离病房单独隔离。患儿母亲自孕15~16周出现低热、咳嗽,产前确诊为“亚急性血行播散型肺结核、结核性脑膜炎”并接受抗结核治疗27天。患儿生后第1天胃液检出少量结核杆菌,痰液检出结核DNA,结核抗体阳性,生后第2天血液标本T-SPOT试验阳性。入院后置负压病房隔离,予以呼吸及营养支持等治疗,生后第2天开始予以异烟肼、利福平、吡嗪酰胺三联抗结核治疗。患儿病情逐渐好转,未出现结核感染的严重症状,于生后第52天(纠正胎龄36^(+4)周)离氧出院,现持续随访中。对疑似先天性结核感染的新生儿,及早诊断和规范化治疗可避免不必要的死亡和残疾发生。

This paper reported the diagnosis and treatment process of a premature infant with congenital tuberculosis.The child was delivered vaginally at 29+1 weeks of gestational age,and was isolated in negative pressure isolation ward of neonatal intensive care unit(NICU)in Zhongnan Hospital of Wuhan University after birth immediately.The mother of the child developed low fever and cough from 15-16 weeks of gestation.She was diagnosed as"subacute hematogenous disseminated tuberculosis and tuberculous meningitis"and received antituberculosis treatment for 27 days.On the first day after birth,a small amount of tuberculosis(TB)bacilli was detected in the gastric juice,TB DNA was detected in the sputum,TB antibody was positive,and T-SPOT test was positive in the blood sample on the second day after birth.After admission,the child was placed in a negative pressure ward for isolation,and given respiration and nutritional support.On the second day after birth,triple antituberculosis therapy with isoniazid,rifampicin and pyrazinamide was executed.The patient's condition gradually improved and no serious symptoms of tuberculosis infection were found.On the 52nd day after birth(corrected gestational age 36^(+4) weeks),he was discharged without oxygen and now in continuous follow-up.This case suggests that early diagnosis and standardized treatment can avoid unnecessary death and disability in neonates suspected of congenital tuberculosis infection.