感染高危儿脐血培养对新生儿早发型败血症的预测价值

The predictive value of umbilical cord blood culture in high-risk infants with infection for early onset sepsis in neonates

摘要

目的 评估感染高危儿中脐血培养对新生儿早发型败血症(EOS)的预测价值。方法 选取2021年1月至2022年12月期间,在唐山市妇幼保健院出生、孕周≥28周且母亲可疑或确诊宫内感染病史的感染高危儿为研究对象,行脐血培养(UCBC).依据UCBC结果,分为UCBC阳性病例组和UCBC阴性病例组.收集研究对象的各项临床指标、理化检验结果及新生儿结局.使用t检验、χ²检验比较UCBC阳性病例组与阴性病例组各指标差异.计算UCBC对EOS的敏感性、特异性、阳性预测值和阴性预测值.绘制受试者工作特征(ROC)曲线分析脐血培养对EOS的诊断价值。结果 本研究共纳入536例感染高危儿脐血培养样本,除4例样本污染外,UCBC阳性病例组60例(11.3%),培养菌种19种,其中以大肠埃希菌最多(51.7%),UCBC阴性病例组472例(88.7%).UCBC阳性与阴性病例组在分娩方式和新生儿转归比较有统计学差异(χ²=23.514和6.35,P<0.05).532例研究对象中临床诊断早发型败血症4例(0.75%),其中UCBC阳性组1例,为肺炎克雷伯氏菌感染,UCBC阴性组3例.UCBC诊断EOS的敏感性为25.0%、特异性为88.8%、阳性预测值(PPV)为1.7%,阴性预测值(NPV)为99.4%、ROC曲线下面积(AUC)为0.569.EOS患儿中,UCBC阳性患儿预后最差,UCBC阴性患儿经治疗后预后均较好。结论 脐血培养尚不能作为早发型败血症诊断的有效预测指标,但脐血培养阴性结果可作为早发型败血症的排除指标.脐血培养污染率高,尤以阴道分娩更为明显,临床上应严格消毒后进行采血.重点监测早产儿及极低出生体重儿的脐血培养结果.

Abstract

Objective To evaluate the predictive value of umbilical cord blood culture (UCBC) for early-onset neonatal sepsis (EOS) in high-risk neonates. Methods Neonates born between January 2021 and December 2022 at Tangshan Maternal and Child Health Care Hospital with a gestational age ≥28 weeks and a history of suspected or confirmed intrauterine infection in the mother were included as high-risk neonates. UCBC was performed, and based on the results, the neonates were divided into a UCBC-positive group and a UCBC-negative group. Clinical indicators, laboratory test results, and neonatal outcomes were collected. Differences between the two groups were compared using t-tests and χ² tests. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of UCBC for EOS were calculated. Receiver operating characteristic (ROC) curves were plotted to analyze the diagnostic value of UCBC for EOS. Results A total of 536 high-risk neonates' UCBC samples were included in this study. After excluding 4 contaminated samples, the UCBC-positive group consisted of 60 cases (11.3%) with 19 different pathogens identified, with Escherichia coli being the most common (51.7%). The UCBC-negative group included 472 cases (88.7%). Statistically significant differences were found between the two groups regarding delivery mode and neonatal outcomes (χ²=23.514 and 6.35, respectively, P<0.05). Among the 532 study participants, 4 cases (0.75%) were clinically diagnosed with EOS, including 1 case in the UCBC-positive group (Klebsiella pneumoniae infection) and 3 cases in the UCBC-negative group. The sensitivity of UCBC for diagnosing EOS was 25.0%, specificity was 88.8%, PPV was 1.7%, NPV was 99.4%, and the area under the ROC curve (AUC) was 0.569. In EOS cases, those with UCBC-positive results had the worst prognosis, while UCBC-negative infants had a better prognosis after treatment. Conclusion Umbilical cord blood culture cannot be used as an effective predictive indicator for the diagnosis of early-onset sepsis. However, a negative UCBC result can be used as an exclusion criterion for EOS. The contamination rate of UCBC is high, especially with vaginal delivery, and strict disinfection procedures should be followed during blood collection. Special attention should be paid to monitoring UCBC results in preterm infants and extremely low birth weight infants.

关键词

感染高危儿 / 新生儿 / 脐血培养 / 早发败血症 / 预测价值

Key words

high-risk infants for infection / neonate / umbilical cord blood culture / early-onset sepsis / predictive value

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基金资助

河北省2023年度医学科学研究课题计划(20231765)