| Sažetak | CILJ ISTRAŽIVANJA: Cilj istraživanja bio je utvrditi učestalost novorođenačke sepse u Zavodu za intenzivnu pedijatriju Klinike za dječje bolesti KBC-a Split kao i kliničke osobitosti te ishod oboljele novorođenčadi u periodu od šesnaest godina (od 1. siječnja 2003. do 31. prosinca 2018.).
MATERIJALI I METODE: U istraživanje je uključeno 128 novorođenčadi oboljele od sepse. Novorođenčad je podijeljena u dvije skupine, ovisno o vrsti sepse: rana (do 7. dana života) ili kasna (od 8. do 28. dana života). Skupine smo usporedili s obzirom na: demografske i antropometrijske karakteristike, porodnu anamnezu, pridružene dijagnoze, dijagnostičke i terapijske postupke te ishod (duljina hospitalizacije, duljina preživljenja).
REZULTATI: Od 771 novorođenčadi primljene u Zavod za intenzivnu pedijatriju, njih 128 (16,6%) liječeno je od sepse. Ranu sepsu imalo je 59 (46%) novorođenčadi, a kasnu sepsu 69 (54%). Medijan porođajne mase bio je 2255 g, a medijan porođajne duljine je bio 46,5 cm. Muškog spola je bilo 85 ispitanika (66%), a ženskog 43 (34%) ispitanika. Među liječenom djecom više je bilo nedonoščadi (78,8%) nego donošene djece (21,2%). Medijan dobi pri prijemu je bio 1 dan. Medijan za Apgar zbroj u 1. i 5. minuti bio je 8. Najčešće pridružene dijagnoze bile su intrakranijalno krvarenje (43,1%), RDS (39,1%) i otvoreni foramen ovale (18,1%). Perinatalna anamneza u najvećem broju slučajeva je bila negativna (32%), a od postavljenih dijagnoza najčešće su bile prijevremeno prsnuće plodovih ovoja (14,1%) i korioamnionitis (10,9%). Medijan vrijednosti za CRP bio je 80,8 mg/L. Prokalcitonin je bio povišen u 88,5% slučajeva. Leukopenija je bila prisutna u 32% ispitanika, a leukocitoza u 42,6%. Trombocitopenija je bila prisutna u 63% ispitanika. Nalaz lumbalne punkcije bio je pozitivan u 12 ispitanika (9,38%). Nalaz hemokulture bio je sterilan u 28,2% slučajeva. U 31,2% slučajeva su izolirane gram-negativne, a u 28,2 % gram-pozitivne bakterije. U 6,5% slučajeva su izolirane gljive, a 5,6% ispitanika imalo je više uzročnika u tri serijski uzete hemokulture. Invazivnu strojnu ventilaciju (konvencionalna strojna ventilacija, HFOV) trebalo je 78% ispitanika, a medijan duljine invazivne ventilacije bio je 9 dana. Surfaktant je primilo 58% ispitanika, a ionotrope 48%. Od antibiotske terapije najviše se koristila kombinirana terapija (osnovni antibiotici i antibiotici rezerve), i to u 40,9% slučajeva. Medijan duljine hospitalizacije bio je 19 dana, a prosječna duljina preživljenja u jedinici intenzivnog liječenja iznosila je 121 dan. Ukupno je umrlo 23% ispitanika. Smrtnost od rane sepse bila je 27%, a od kasne 19%.
ZAKLJUČCI: Dokazali smo statistički značajnu razliku u dobi prijema, vrijednosti CRP-a, duljini trajanja invazivne ventilacije, upotrebi surfaktanta i duljini trajanja hospitalizacije u odnosu na vrstu sepse. |
| Sažetak (engleski) | OBJECTIVES: The main objective was to determine incidence of sepsis, clinical characteristics and outcome in newborns treated in the PICU, Department of pediatrics, University Hospital of Split in period of 16 years (from January 1st 2003 to December 31st 2018).
PATIENTS AND METHODS: 128 newborns with sepsis were included in this research. Newborns were divided into two groups depending on the type of sepsis: early-onset (<7 days of life) or late-onset (8-28 days of life). The groups were compared regarding demographic and antropometric characteristics, birth history, associated diagnoses, diagnostic and therapeutic procedures and outcome (lenght of hospitalisation, lenght of survival).
RESULTS: .Out of 771 newborns that were treated in the intensive care unit, 128 (16.6%) had sepsis, 59 (46%) had early-onset sepsis and 69 (54%) had late-onset sepsis. Median for birth weight of treated children was 2255 g and median of birth lenght was 46,5 cm. Out of a total number of children 85 (66%) were male. There was 78.8% preterm newborns and 21.2% term newborns. Median of age when affected newborns were admitted was 1 day. Median of Apgar score both in 1st and 5th minute was 8. The most common associated diagnoses were intracranial hemorrhage (43.1%), RDS (39.1%) and patent foramen ovale (18.1%). In most cases perinatal anamnesis was negative (32%), and most commom diagnoses were: premature ruptures of membranes (14.1%) and chorioamnionitis (10.9%). Median of CRP value was 80.8 mg/L. Values of procalcitonin were high in 88.5% patients. Out of a total number of subjects 32% had leucopenia and 42.6% had leucocytosis. Trombocytopenia was found in 63% of patients. The results of lumbar puncture were positive for meninghitis in 12 patients (9.38%). The results of hemoculture were negative in 28.2% subjects, in 31.2% subjects gram-negative bacteria were isolataed, in 28.2% gram-positivne bacteria were isolated. In 6.5% of subjects fungi were isolated and 5.6% subjects had more than one bacteria isolated out of three hemocultures taken. Out of a total number of patients 78% had some form of invasive ventilation (conventional mechanical ventilation, HFOV) as a part of treatment and median of lenght of invasive ventilation was 9 days. 58% of subjects were treated with surfactant and 48% of them had ionotrope as a part of their therapy. Combined antibiotic therapy of common antibiotics and antibiotics for treating multi-drug resistent bacteria was the most common type of antimicrobial therapy, in 40.9% patients. Median of lenght of hospitalisation was 19 days and average lenght of survival in the intensive care unit was 121 days. Out of a total number of patients, 23% died. Mortality rate in early-onset sepsis group was 27% and in late-onset sepsis group mortality rate was 19%.
CONCLUSION: Age when affected newborns were admitted in the intensive care unit, values of CRP, lenght of invasive ventilation, use of surfactant and lenght of hospitalisation had stastistically significant effect regarding type of sepsis (early-onset sepsis or late-onset sepsis). |
