新生兒敗血症

10.6666/ClinMed.201910_84(4).0112

廖曉茹；鄭玫枝

新生兒敗血症（neonatal sepsis） ； 早發型敗血症（early-onset sepsis） ； 晚發型敗血症（late-onset sepsis）

臨床醫學月刊

84卷4期（2019 / 10 / 25）

674 - 682

繁體中文

新生兒敗血症在新生兒死亡原因中大約占15%，由於症狀不典型或表現不明顯，臨床上判斷新生兒敗血症並不容易。新生兒敗血症分為早發型及晚發型，最常見的定義以出生7天為分界。早發型敗血症主要是透過母親產道、子宮或羊水內的病原菌垂直傳染，晚發型敗血症則可能是垂直傳染的病原菌過度生長致病，或是新生兒受環境或照顧者身上的病原菌入侵而致病。常見的新生兒敗血症病原菌包括乙型鏈球菌（group B streptococcus）、大腸桿菌（Escherichia coli）、凝固酶陰性的葡萄球菌（coagulase-negative Staphylococcus）及李斯特菌（Listeria）等等。新生兒敗血症臨床症狀極不典型。當新生兒出現體溫不穩定、呼吸症狀、循環系統症狀或神經學症狀時都要高度懷疑敗血症。臨床上應詳細詢問生產過程並評估敗血症的風險。檢驗項目應包括血液培養、全血細胞計數及白血球分類計數（CBC, DC）、腰椎穿刺、C反應蛋白（C-reactive protein，CRP）、前降鈣素（procalcitonin）、胸部X光（若有呼吸症狀）、氣管內管的抽吸培養等。若是懷疑晚發型敗血症，要加做懷疑感染部位的培養以及尿液培養。經驗性的抗生素以ampicillin合併gentamicin為首選。若擔心腦膜炎或ampicillin抗藥菌，則需使用第三代cephalosporin（例如：cefotaxime）。若為院內感染，則使用vancomycin合併gentamicin。新生兒敗血症的死亡率約為2～4%，而早產兒不只是新生兒敗血症的高危險群，低出生體重更是未來共病症的危險因子，值得臨床醫師特別關注。

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