- 期刊
Systemic Fungal Infection in Very Low-Birth-Weight Infants
極低出生體重嬰兒的全身性黴菌感染
摘要
這篇回朔性的研究是在探討極低出生體重的早産兒，發生全身性黴菌感染的相關因素及預後。從1990年1月到1994年6月一共有262個極低出生體重的早産兒住進大醫院的生兒加護病房，其中有15位(5.7%)罹患黴菌血症（14位爲念珠菌，1位爲隱球菌）。這些黴菌血症的嬰兒，60%合併有泌尿道感染，18%合併有腦膜炎。他們平均出生體重爲1079±78g(504-1474g)，出生週數爲28.6±0.6週（23-32週）。其中13位(87%)有呼吸窘迫症候群及開放性動脈導管，60%有慢性肺疾病。這些嬰兒接受靜脈營養、抗生素、氣管插管、中央靜脈導管及類固醇治療的比例分別爲100%、1001%、73%、67%及36%。診斷出黴菌血症的平均年齡是40.5±4.8天（10-76天）。其常見的臨床表現集資爲呼吸狀況惡化(93%)、喂食不(58%)及發燒(53%)。以amphotericin B治療全身性黴菌感染的副作用，其發生的頻率依次爲低血鉀(54%)低血鈉(31%)及尿量減少(23%)。死亡率爲40%。因此極低出生體重嬰兒若發生全身性黴菌感染，可能 導致高死亡率，而且接受amphotericin B治療後有很高的比例産生副作用。
並列摘要
This retrospective study was designed to investigate the related factors and outcome of systemic fungal infection in very low-birth-weight (VLBW) infants. Medical records of infants admitted to the neonatal intensive care unit of National Cheng Kung University Hospital between January 1990 and June 1994 were reviewed. Of the 262 VLBW infants, 15(5.7%) had fungemia (14 Candida. 1 Crvptococcus) during the study period. Among the fungemic infants, 60% also had urinary tract infection; 18% had central nervous system infection. Their mean birth weight was 1079±78 g (504-1474 g), and the gestational age was 28.6 ± 0.6 weeks (23-32 weeks). Thirteen of them (87%) had respiratory distress syndrome and patent ductus arteriosus, while 60% had chronic lung disease. The percentage of antibiotic usage, parenteral hyperalimentation, endotracheal intubation, placement of central venous line and steroid therapy were 100%, 100%, 73%, 67% and 36% respectively. The mean age at diagnosis of fungemia was 40.5±4.8 days (10-76 days). Common clinical manifestations were respiratory deterioration (93%), poor feeding (58%) and fever (53%). The frequency of side effects of amphotericin B in decreasing order were: hypokalemia (54%), hyponatremia (31%) and decreased urine amount (23%). The mortality rate was 40%. It was concluded that systemic fungal infection in VLBW infants might result in high mortality and the side effects were high in the treated infants.