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目的分析NICU中新生儿侵袭性真菌感染的临床特点,为合理诊治提供依据。方法回顾性分析2009年11月-2011年11月本院NICU收治的27例侵袭性真菌感染患儿的临床资料,包括患儿一般资料、高危因素、临床症状、实验室检查、治疗及转归。结果 27例中早产儿25例(92.59%),其中极低出生体质量儿19例,超低出生体质量儿5例。患儿均接受广谱抗生素治疗和静脉营养,23例留置中心静脉导管(PICC),19例曾予机械通气,14例使用质子泵抑制剂。早期临床表现以呼吸暂停和喂养不耐受为主。实验室检查发现23例血小板进行性下降;24例1,3-β-D葡聚糖(BG)升高;7例脑脊液异常。26例血培养阳性均为念珠菌感染。7例中枢感染患儿头颅B超和MRI有异常表现。患儿均接受氟康唑、两性霉素B脂质体治疗,20例治愈,4例放弃治疗,3例死亡。结论新生儿侵袭性真菌感染多发于胎龄小于32周的极低出生体质量儿。反复呼吸暂停和喂养不耐受为早期主要临床表现,是早期识别和诊断的重要线索。动态监测血小板计数和BG是早期诊断的重要方法。氟康唑和两性霉素B脂质体对新生儿侵袭性真菌感染有良好疗效。规范广谱抗生素应用、加强PICC管理、严格掌握上机和撤机指征、尽早过渡至肠内营养是预防真菌感染的重要措施。
Objective To analyze the clinical features of neonatal invasive fungal infection in the NICU and provide the basis for reasonable diagnosis and treatment. Methods The clinical data of 27 children with invasive fungal infection admitted to NICU from November 2009 to November 2011 were analyzed retrospectively, including general information, risk factors, clinical symptoms, laboratory tests, treatment and outcome in children . Results Twenty-five cases (92.59%) of preterm infants in 27 cases, including 19 cases of very low birth weight and 5 cases of low birth weight. Children received broad-spectrum antibiotic therapy and parenteral nutrition. Twenty-three patients underwent central venous catheterization (PICC), 19 received mechanical ventilation, and 14 received proton pump inhibitors. Early clinical manifestations of apnea and feeding intolerance dominated. Twenty-three cases of 1,3-β-D-glucan (BG) increased in laboratory tests and 23 cases of cerebrovascular abnormalities. 26 cases of blood culture positive Candida infection. Seven cases of central infection in children with abnormal B-head and MRI showed abnormalities. Children received fluconazole, amphotericin B liposome treatment, 20 cases were cured, 4 patients give up treatment, 3 patients died. Conclusions Neonatal invasive fungal infections occur in very low birth weight infants less than 32 weeks gestational age. Repeated apnea and feeding intolerance as the main clinical manifestations of early, early identification and diagnosis of important clues. Dynamic monitoring of platelet counts and BG is an important method of early diagnosis. Fluconazole and amphotericin B liposomes have a good effect on neonatal invasive fungal infections. Regulate the application of broad-spectrum antibiotics, strengthen the PICC management, strictly control the indications on the machine and weaning, as early as possible transition to enteral nutrition is an important measure to prevent fungal infections.