新生儿败血症：需要共识定义、合作和核心结果,Pediatric Research

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新生儿败血症：需要共识定义、合作和核心结果
Pediatric Research ( IF 3.1 ) Pub Date : 2020-03-19 , DOI: 10.1038/s41390-020-0850-5
Eleanor J Molloy _{1,

2,

3,

4} , James L Wynn ₅ , Joseph Bliss ₆ , Joyce M Koenig ₇ , Fleur M Keij ₈ , Matt McGovern _{1,

2} , Helmut Kuester ₉ , Mark A Turner ₁₀ , Eric Giannoni ₁₁ , Jan Mazela ₁₂ , Marina Degtyareva ₁₃ , Tobias Strunk _{14,

15} , Sinno H P Simons ₈ , Jan Janota ₁₆ , Franz B Plotz ₁₇ , Ages van den Hoogen ₁₈ , Willem de Boode ₁₉ , Luregn J Schlapbach _{20,

21} , Irwin K M Reiss ₈ ,

Affiliation

Paediatrics, Academic Centre, Children's Hospital Ireland (CHI) at Tallaght, Trinity College, the University of Dublin, Dublin, Ireland.
Trinity Translational Medicine Institute, St James' Hospital, Dublin, Ireland.
Neonatology, Coombe Women and Infants' University Hospital, Dublin, Ireland.
Neonatology, CHI at Crumlin, Dublin, Ireland.
Departments of Paediatrics & Pathology, Immunology and Laboratory Medicine, University of Florida, Gainesville, FL, USA.
Department of Pediatrics, Women & Infants Hospital of Rhode Island, Alpert Medical School of Brown University, Providence, RI, USA.
Division of Neonatology, Saint Louis University, Edward Doisy Research Center, St. Louis, MO, USA.
Department of Pediatrics, Division of Neonatology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands.
Neonatology, Clinic for Paediatric Cardiology and Intensive Care, University Medical Centre Göttingen, Göttingen, Germany.
Institute of Translational Medicine, University of Liverpool, Centre for Women's Health Research, Liverpool Women's Hospital, Liverpool, UK.
Childrens Hospital Clinic of Neonatology, Department Mother-Woman-Child, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland.
Department of Neonatology and Infectious Diseases, Poznan University of Medical Sciences, Poznan, Poland.
Neonatology, Pirogov Russian National Research Medical University, Moscow, Russia.
Neonatal Health and Development, Telethon Kids Institute, Perth, WA, Australia.
Neonatal Directorate, King Edward Memorial Hospital for Women, Perth, WA, Australia.
Department of Neonatology, Thomayerova nemocnice, Prague, Czechia.
Department of Pediatrics, Tergooi Hospital, Blaricum, The Netherlands.
Neonatology, Wilhelmina Childrens Hospital, University Medical Center, Utrecht, The Netherlands.
Radboud Institute for Health Sciences, Department of Neonatology, Radboud University Medical Center, Amalia Children's Hospital, Nijmegen, The Netherlands.
Paediatric Critical Care Research Group, Child Health Research Centre, University of Queensland, Paediatric Intensive Care Unit, Queensland Children's Hospital, Brisbane, QLD, Australia.
Department of Pediatrics, Bern University Hospital, University of Bern, Bern, Switzerland.

新生儿脓毒症概述和定义脓毒症是导致全球死亡率的主要因素，已被世界卫生组织宣布为优先事项。所有年龄组的脓毒症发病率最高的是新生儿，估计影响全球 300 万婴儿（每 1000 名活产婴儿中有 22 名），死亡率为 11-19%，长期神经系统缺陷无法量化。然而，由于缺乏新生儿败血症的统一标准，国际数据难以标准化。最近，在成人中，脓毒症和脓毒性休克的第三个国际共识定义 (Sepsis-3) 将脓毒症定义为由对感染的反应失调引起的危及生命的器官功能障碍。新的共识定义摆脱了全身炎症反应综合征的概念，这构成了过去 20 年脓毒症定义的一部分。Sepsis-3 标准是在来自成人脓毒症患者的大量电子健康记录数据中开发和验证的。尽管 Sepsis-3 工作组选择的方法有明显的优点，但将 Sepsis-3 转化为新生儿仍存在一些缺陷。定义感染和脓毒症的标准对于新生儿人群来说是必不可少的，以限制过度诊断，但它们不是成人脓毒症 3 定义的一部分。Sepsis-3 仅基于短期结果，但在新生儿中，长期残疾预测因素的整合至关重要。根据孕龄和产后年龄确定器官功能障碍的标准需要通过系统评价和回顾性研究来确定，并在前瞻性研究中进行验证。序贯器官衰竭评估评分 (SOFA) 反映器官功能相对于基线的变化。pSOFA 已被提出并被发现是儿童住院死亡率的可靠预测指标。最近描述的新生儿 SOFA (nSOFA) 预测了患有迟发性败血症的极低出生体重 (VLBW) 婴儿的死亡率。在本期杂志中，一个国际小组概述了新生儿败血症的不同定义，旨在达成国际共识。

"点击查看英文标题和摘要"

Neonatal sepsis: need for consensus definition, collaboration and core outcomes

OVERVIEW OF NEONATAL SEPSIS AND DEFINITIONS Sepsis represents a major contributor to global mortality and has been declared as a priority by the WHO. The highest sepsis incidence across all age groups is found in neonates affecting an estimated 3 million babies worldwide (22 per 1000 live births) with a mortality of 11–19% and unquantified long-term neurological defects. However, international data are difficult to standardise in the absence of unified criteria for neonatal sepsis. Recently, in adults, the Third International Consensus Definitions for Sepsis and Septic Shock (Sepsis-3) have defined sepsis as a life-threatening organ dysfunction caused by a dysregulated response to infection. The new consensus definition moved away from the concept of systemic inflammatory response syndrome, which formed part of the definition of sepsis in the past 20 years. Sepsis-3 criteria were developed and validated on large cohorts of electronic health record data-derived episodes from adults with sepsis. Despite the clear merits of the approach chosen by the Sepsis-3 taskforce, there are several pitfalls towards the translation of Sepsis-3 to neonates. The criteria to define infection and sepsis are essential in the neonatal population to limit overdiagnosis, but they are not part of the adult Sepsis-3 definitions. Sepsis-3 is based only on short-term outcomes but in neonates integration of predictors of long-term disability is critical. The criteria for organ dysfunction according to gestational and postnatal age need to be defined through systematic reviews and retrospective studies and validated in prospective studies. The Sequential Organ Failure Assessment Score (SOFA) reflects changes in organ function altering from baseline. The pSOFA has been proposed and was found to be a reliable predictor of inhospital mortality in children. The recently described neonatal SOFA (nSOFA) predicted mortality on Very Low Birth Weight (VLBW) infants with late onset sepsis. In this issue of the journal an international group has provided an overview of the diverse definitions of neonatal sepsis with the aim of working towards international consensus.

更新日期：2020-03-19

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