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首页> 外文期刊>Pediatrics: Official Publication of the American Academy of Pediatrics >Stratification of risk of early-onset sepsis in newborns ≥34 weeks' gestation
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Stratification of risk of early-onset sepsis in newborns ≥34 weeks' gestation

机译：妊娠≥34周的新生儿发生早发败血症的风险分层

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OBJECTIVE: To define a quantitative stratification algorithm for the risk of early-onset sepsis (EOS) in newborns ≤34 weeks' gestation. METHODS: We conducted a retrospective nested case-control study that used split validation. Data collected on each infant included sepsis risk at birth based on objective maternal factors, demographics, specific clinical milestones, and vital signs during the first 24 hours after birth. Using a combination of recursive partitioning and logistic regression, we developed a risk classification scheme for EOS on the derivation dataset. This scheme was then applied to the validation dataset. RESULTS: Using a base population of 608 014 live births ≤34 weeks' gestation at 14 hospitals between 1993 and 2007, we identified all 350 EOS cases <72 hours of age and frequency matched them by hospital and year of birth to 1063 controls. Using maternal and neonatal data, we defined a risk stratification scheme that divided the neonatal population into 3 groups: treat empirically (4.1% of all live births, 60.8% of all EOS cases, sepsis incidence of 8.4/1000 live births), observe and evaluate (11.1% of births, 23.4% of cases, 1.2/1000), and continued observation (84.8% of births, 15.7% of cases, incidence 0.11/1000). CONCLUSIONS: It is possible to combine objective maternal data with evolving objective neonatal clinical findings to define more efficient strategies for the evaluation and treatment of EOS in term and late preterm infants. Judicious application of our scheme could result in decreased antibiotic treatment in 80 000 to 240 000 US newborns each year.
机译：目的：为妊娠≤34周的新生儿定义定量分层算法，用于早期发作败血症（EOS）的风险。方法：我们进行了一项回顾性嵌套病例对照研究，该研究使用拆分验证。基于客观的母亲因素，人口统计学，特定的临床里程碑以及出生后头24小时内的生命体征，收集到的每个婴儿的数据都包括出生时的败血症风险。通过结合递归分区和逻辑回归，我们在派生数据集上开发了EOS风险分类方案。然后将此方案应用于验证数据集。结果：我们使用1993年至2007年间14家医院的608 014名活产婴儿≤34周的胎龄，我们确定了所有350例<72小时和频率的EOS病例，按医院和出生年份与1063名对照相匹配。利用母婴数据，我们定义了一种风险分层方案，将新生儿人群分为三类：凭经验治疗（占所有活产婴儿的4.1％，占所有EOS病例的60.8％，败血症发生率为8.4 / 1000个活产婴儿），观察和评估（11.1％的出生，23.4％的病例，1.2 / 1000），并继续观察（84.8％的出生，15.7％的病例，发生率0.11 / 1000）。结论：有可能将客观的母体数据与不断发展的客观新生儿临床发现相结合，以定义更有效的策略来评估和治疗足月和早产儿的EOS。明智地采用我们的计划可能会导致每年80,000至24万美国新生儿减少抗生素治疗。

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