一例新生儿败血症、早期诊断和预防性重症监护

IF 0.1 Q4 MEDICINE, GENERAL & INTERNAL
M. Kurochkin, A. Davydova, O. M. Krupinova
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引用次数: 0

摘要

新生儿败血症是任何感染过程的并发症,是一种危及新生儿生命的病理过程。向从业人员介绍一例新生儿败血症病例,及时诊断和重症监护有助于防止脓毒性休克和多器官功能衰竭的发生。扎波罗热市第五儿科医院麻醉科和新生儿重症监护室收治了一名患儿。他接受了医院设备提供的临床和生化血液化验、微生物学、放射学和超声波检查。患儿产前病史复杂,在妊娠 34 周时因重度先兆子痫紧急剖腹产。出生后第 10 天,婴儿出现中毒综合征和发热症状。X 射线检查显示婴儿患有右侧肺炎;临床血细胞计数显示白细胞增多并伴有急性炎症变化、血小板减少和降钙素原水平升高。一天后,炎症变化急剧恶化,脑脊液细胞增多至 850 个,以中性粒细胞为主。经血液培养,发现肠杆菌呈阳性。医生根据降级原则为患儿开出了抗菌治疗处方(美罗南和万古霉素),并根据微生物检查结果对处方进行了调整,同时还为患儿提供了肠外营养输液治疗、免疫抑制(静脉注射免疫球蛋白)和抗真菌治疗。经过强化治疗,临床血细胞计数炎症异常得到缓解,脑脊液完全恢复健康,降钙素原和 C 反应蛋白水平恢复正常,肺炎在一周内痊愈。实验室的积极变化与全身情况相关:体温恢复正常、活动增加、肠道喂养能力增强。由革兰阴性菌群引起的新生儿败血症的及时诊断和重症监护有助于防止多器官功能衰竭和脓毒性休克的发生。对于脓毒血症高危新生儿,根据降级原则使用抗生素治疗是合理的。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
A case of neonatal sepsis, early diagnosis and preventive intensive care
Neonatal sepsis is a pathological process that occurs as a complication of any infectious processes and is a life-threatening condition for newborns. Aim. To inform practitioners with the case of neonatal sepsis, when timely diagnosis and intensive care helped to prevent the development of septic shock and multiple organ failure. Materials and methods. A child was treated in the Department of Anesthesiology and Intensive Care of Newborns of Zaporizhzhia City Pediatric Hospital No. 5. He underwent clinical and biochemical blood tests, microbiological, radiological and ultrasound examinations using the hospital equipment. Results. The child with a complicated prenatal history was born by emergency caesarean section for severe pre-eclampsia at 34 weeks’ gestation. On the tenth day of life, the infant developed a worsening intoxication syndrome and febrile temperature. X-ray examinations revealed right-sided pneumonia; clinical blood count showed leukocytosis with acute inflammatory changes, thrombocytopenia, and an elevated procalcitonin level. A day later, the inflammatory changes dramatically deteriorated, and the cerebrospinal fluid cytosis was increased up to 850 cells and dominated by neutrophils. Blood cultures tested positive for Enterobacter cloacae. The child was prescribed antibacterial therapy according to the de-escalation principle (meronem and vancomycin) with subsequent changes according to the results of microbiological examinations, infusion therapy with parenteral nutrition, immunosupportive (intravenous immunoglobulin) and antifungal therapy. As a result of intensive therapy, clinical blood count inflammatory abnormalities were regressed, cerebrospinal fluid was completely restored to health, procalcitonin and C-reactive protein levels were normalized, and pneumonia was resolved within a week. Positive laboratory changes were correlated with the general condition: normalization of body temperature, increased activity, and enteral feeding ability. Conclusions. Timely diagnosis and intensive care of neonatal sepsis caused by gram-negative flora helped to prevent the development of multiple organ failure and septic shock. The use of antibiotic therapy according to the de-escalation principle is justified in newborns at high risk of developing septicaemia.
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来源期刊
Zaporozhye Medical Journal
Zaporozhye Medical Journal MEDICINE, GENERAL & INTERNAL-
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72
审稿时长
8 weeks
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