摘要
目的探讨新生儿流行性感冒(简称流感)的临床特点、诊断及治疗。方法对首都医科大学附属北京儿童医院新生儿中心2016年5月至2019年4月收治的流感患儿临床资料进行回顾性分析。结果共收治30例,其中甲型流感23例,乙型流感7例。轻症流感19例,重症流感7例,危重流感4例。发病前有流感接触史25例。临床表现中发热25例,吐沫17例,纳差16例,咳嗽14例,呼吸困难4例,少数伴有腹泻、呕吐。30例患儿流感病毒抗原检测均阳性。白细胞总数正常21例,降低8例,升高1例;血C反应蛋白升高6例;谷丙转氨酶升高3例,肌酸激酶同工酶MB升高2例。19例行痰培养,阳性6例,其中金黄色葡萄球菌4例,流感嗜血杆菌+金黄色葡萄球菌2例。合并双侧肺炎7例、呼吸衰竭3例、呼吸衰竭+休克1例。7例抗病毒治疗,其中6例口服奥司他韦,1例静脉点滴帕拉米韦。4例呼吸支持(3例无创,1例有创)。29例好转或痊愈出院,1例危重症病例放弃治疗死亡。结论流感病毒抗原检测有助于新生儿流感的早期诊断,新生儿使用神经氨酸酶抑制剂抗病毒治疗安全有效,合并细菌感染时需合理使用抗生素,新生儿流感总体预后良好。
Objective To study the clinical characteristics,diagnosis and treatment of neonatal influenza.Method From May 2016 to April 2019,the clinical data of children with influenza admitted to the Neonatal Center of our hospital were retrospectively analyzed.Result A total of 30 cases were admitted,including 23 cases of influenza A and 7 cases of influenza B.19 cases had mild type of influenza,7 cases had severe type and 4 cases critical type.25 cases had a history of flu exposure before the onset.25 patients had fever,17 excessive saliva,16 poor appetite,14 cough,4 dyspnea and some patients had diarrhea and vomiting.All patients had positive influenza virus antigen tests.White blood cell count was normal in 21 cases,decreased in 8 cases and increased in 1 case.C-reactive protein(CRP)was increased in 6 cases.3 cases had increased alanine aminotransferase and 2 cases increased creatine kinase isoenzyme MB(CK-MB).Sputum culture was performed in 19 cases and 6 cases were positive,including 4 cases of Staphylococcus aureus and 2 cases of Haemophilus influenzae combined with Staphylococcus aureus.7 cases had bilateral pneumonia,3 cases respiratory failure and 1 case respiratory failure and shock.7 cases were treated with antiviral therapy,including 6 cases of oral oseltamivir and 1 case of intravenous peramivir.4 cases received respiratory support including noninvasive support in 3 cases and mechanical ventilation in one case.29 cases recovered and were discharged and one critically-ill case refused treatment and died.Conclusion Influenza virus antigen test is helpful for early diagnosis of neonatal influenza.Neuraminidase inhibitors used for neonates are safe and effective.Antibiotics should be used with caution if bacterial infection occured.The overall prognosis of neonatal influenza is good.
作者
刘蕾
董世霄
翁景文
黑明燕
丁翊君
郑侠
王亚娟
Liu Lei;Dong Shixiao;Weng Jingwen;Hei Mingyan;Ding Yijun;Zheng Xia;Wang Yajuan(Department of Neonatology,Beijing Children's Hospital,Capital Medical University,National Center for Children's Health,Beijing 100045,China)
