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首页> 外文期刊>Pediatrics: Official Publication of the American Academy of Pediatrics >Interpreting complete blood counts soon after birth in newborns at risk for sepsis.
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Interpreting complete blood counts soon after birth in newborns at risk for sepsis.

机译：患有败血症风险的新生儿出生后不久便要解释全血细胞计数。

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BACKGROUND: A complete blood count (CBC) with white blood cell differential is commonly ordered to evaluate newborns at risk for sepsis. OBJECTIVES: To quantify how well components of the CBC predict sepsis in the first 72 hours after birth. METHODS: For this retrospective cross-sectional study we identified 67 623 term and late-preterm (>/= 34 weeks gestation) newborns from 12 northern California Kaiser hospitals and 1 Boston, Massachusetts hospital who had a CBC and blood culture within 1 hour of each other at <72 hours of age. We compared CBC results among newborns whose blood cultures were and were not positive and quantified discrimination by using receiver operating characteristic curves and likelihood ratios. RESULTS: Blood cultures of 245 infants (3.6 of 1000 tested newborns) were positive. Mean white blood cell (WBC) counts and mean absolute neutrophil counts (ANCs) were lower, and mean proportions of immature neutrophils were higher in newborns with infection; platelet counts did not differ. Discrimination improved with age in the first few hours, especially for WBC counts and ANCs (eg, the area under the receiver operating characteristic curve for WBC counts was 0.52 at <1 hour and 0.87 at >/= 4 hours). Both WBC counts and ANCs were most informative when very low (eg, the likelihood ratio for ANC < 1000 was 115 at >/= 4 hours). No test was very sensitive; the lowest likelihood ratio (for WBC count >/= 20 000 at >/= 4 hours) was 0.16. CONCLUSION: Optimal interpretation of the CBC requires using interval likelihood ratios for the newborn's age in hours.
机译：背景：通常要求用全血细胞计数（CBC）和白细胞鉴别来评估有败血症风险的新生儿。目的：量化出生后头72小时内CBC成分对败血症的预测效果。方法：在这项回顾性横断面研究中，我们确定了来自北加州凯撒（Kaiser）12家医院和马萨诸塞州波士顿1所医院的1个月内有CBC和血液培养的67 623名足月和早产儿（> / =妊娠34周）彼此之间的年龄小于72小时。我们比较了血培养为阳性和非阳性的新生儿的CBC结果，并通过使用接收者操作特征曲线和似然比来量化区分。结果：245名婴儿（每1000名接受测试的新生儿中有3.6名）的血培养呈阳性。在感染的新生儿中，平均白细胞（WBC）计数和平均中性粒细胞绝对计数（ANC）较低，未成熟中性粒细胞的平均比例较高。血小板计数没有差异。在最初的几个小时内，随着年龄的增长，歧视有所改善，尤其是对于WBC计数和ANC（例如，接收器工作特性曲线下的WBC计数区域在<1小时为0.52，在> / = 4小时为0.87）。当非常低时，WBC计数和ANC都提供最多的信息（例如，ANC <1000在> / = 4小时时的似然比为115）。没有测试是非常敏感的。最低似然比（WBC计数> / = 4小时时> / = 20000）为0.16。结论：对CBC的最佳解释要求使用新生儿年龄的小时数间隔似然比。

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