新生儿败血症疾病负担的国际比较（1990—2021）及中国启示

doi:10.12372/jcp.2025.25e0179

摘要/Abstract

摘要：

目的新生儿败血症（NS）是全球新生儿死亡的第三大原因，其疾病负担在发展中国家和发达国家之间，存在显著差异。将发达和发展中国家NS疾病负担情况进行对比分析，为我国制定更有效的防控措施提供循证依据，减轻NS的疾病负担。方法从全球疾病负担数据库2021（GBD 2021）中提取1990—2021年，全球、美国、中国和印度NS患病、发病和死亡数据，包括例数、率以及其标化率。运用Joinpoint回归模型分析时间趋势，并计算年度变化百分比（APC）与平均年度变化百分比（AAPC）。预测全球、美国、中国和印度2021年至2035年NS标化患病率、发病率及死亡率变化趋势。结果截止2021年全球NS患病例数9 661 523例，死亡例数232 656例。与1990年相比，2021年全球NS标化患病率上升34.5%，而标化发病率及死亡率分别下降20.6%和21.2%。1990—2021年间，印度NS标化患病率、发病率和死亡率均高于全球平均水平。中国NS标化患病率呈上升趋势，美国则基本保持稳定；中国NS标化发病率及死亡率下降幅度最大，分别为35.7%和65.8%。结论 1990—2021年，NS的疾病负担在全球范围内呈下降趋势，建议进一步优化医疗资源均衡配置，促进NS疾病负担降低。

关键词: 新生儿败血症, 全球疾病负担, 患病率, 发病率, 死亡率

Abstract:

Objective Neonatal sepsis (NS) is the third cause of neonatal deaths in the world, with significant differences in disease burden between developing and developed countries. The disease burden of NS in developed and developing countries was compared to provide an evidence-based basis for China to formulate more effective prevention to reduce the disease burden of NS. Methods The NS data of prevalence, incidence, and deaths including number,rate and age standard rate,were extracted from the Global Burden of Diseases 2021 (GBD 2021) database for 1990-2021 in the global, America, China, and India. The Joinpoint regression model was used to analyze the trend, and annual percentage change (APC) and average annual percentage change (AAPC) were calculated. To forecast trends in NS age standard prevalence, incidence, and deaths in the global, America, China, and India from 2021 to 2035. Results As of 2021, the global number of NS prevalence was 9661523, and the number of deaths was 232656. In 2021, compared with 1990, the global age standard prevalence of NS increased by 34.5%,while age standard incidence and deaths respectively decreased 20.6% and 21.2%. From 1990 to 2021, the age standard prevalence, incidence and deaths in India were all higher than the global average. Age standard prevalence in China is increased, while in America it has remained stable. China showed the largest decline in age standard incidence and deaths of NS (35.7% and 65.8%, respectively). Conclusion From 1990 to 2021, the global disease burden of NS showed a downward trend. It is suggested to further optimize the balanced allocation of medical resources to promote the reduction of NS disease burden.

Key words: neonatal sepsis, global burden of diseases, prevalence, incidence, deaths

中图分类号:

曾仕诚, 冯昆, 周娴璐, 华子瑜. 新生儿败血症疾病负担的国际比较（1990—2021）及中国启示[J]. 临床儿科杂志, 2025, 43(9): 670-679.

ZENG Shicheng, FENG Kun, ZHOU Xianlu, HUA Ziyu. International comparison of disease burden of neonatal sepsis (1990-2021) and implications for China[J]. Journal of Clinical Pediatrics, 2025, 43(9): 670-679.

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参考文献 29

[1]	Strunk T, Molloy E J, Mishra A, et al. Neonatal bacterial sepsis[J]. Lancet, 2024, 404(10449): 277-293.
[2]	Celik IH, Hanna M, Canpolat FE, et al. Diagnosis of neonatal sepsis: the past, present and future[J]. Pediatr Res, 2022, 91(2): 337-350.
[3]	Attia HMH, Parekh R, Dhandibhotla S, et al. Insight Into Neonatal Sepsis: An Overview[J]. Cureus, 2023, 15(9): e45530.
[4]	Milton R, Gillespie D, Dyer C, et al. Neonatal sepsis and mortality in low-income and middle-income countries from a facility-based birth cohort: an international multisite prospective observational study[J]. Lancet Glob Health, 2022, 10(5): e661-e672.
[5]	Fang P, Gao K, Yang J, et al. Prevalence of multidrug-resistant pathogens causing neonatal early and late onset sepsis, a retrospective study from the tertiary referral children's hospital[J]. Infect Drug Resist, 2023, 16: 4213-4225. doi: 10.2147/IDR.S416020 pmid: 37404253
[6]	Global incidence, prevalence, years lived with disability (YLDs), disability-adjusted life-years (DALYs), and healthy life expectancy (HALE) for 371 diseases and injuries in 204 countries and territories and 811 subnational locations, 1990-2021: a systematic analysis for the Global Burden of Disease Study 2021[J]. Lancet, 2024, 403(10440): 2133-2161.
[7]	Global burden and strength of evidence for 88 risk factors in 204 countries and 811 subnational locations, 1990-2021: a systematic analysis for the Global Burden of Disease Study 2021[J]. Lancet, 2024, 403(10440): 2162-2203. doi: 10.1016/S0140-6736(24)00933-4 pmid: 38762324
[8]	Global age-sex-specific mortality, life expectancy, and population estimates in 204 countries and territories and 811 subnational locations, 1950-2021, and the impact of the COVID-19 pandemic: a comprehensive demographic analysis for the Global Burden of Disease Study 2021[J]. Lancet, 2024, 403(10440): 1989-2056. doi: 10.1016/S0140-6736(24)00476-8 pmid: 38484753
[9]	Kim HJ, Fay MP, Feuer EJ, et al. Permutation tests for joinpoint regression with applications to cancer rates[J]. Stat Med, 2000, 19(3): 335-351. doi: 10.1002/(sici)1097-0258(20000215)19:3<335::aid-sim336>3.0.co;2-z pmid: 10649300
[10]	Wang X, Xiu R, Gong L, et al. Unraveling the global burden of inflammatory bowel disease (1990-2019): A Joinpoint regression analysis of divergent trends in 10-24 and 50-69 age cohorts[J]. Autoimmun Rev, 2024, 23(6): 103586.
[11]	Riebler A, Held L. Projecting the future burden of cancer: Bayesian age-period-cohort analysis with integrated nested Laplace approximations[J]. Biom J, 2017, 59(3): 531-549. doi: 10.1002/bimj.201500263 pmid: 28139001
[12]	Cao G, Liu J, Liu M. Global, regional, and national incidence and mortality of neonatal preterm birth, 1990-2019[J]. JAMA Pediatr, 2022, 176(8): 787-796.
[13]	Ryan L, Plötz FB, van den Hoogen A, et al. Neonates and COVID-19: state of the art : Neonatal Sepsis series[J]. Pediatr Res, 2022, 91(2): 432-439.
[14]	Guo L, Han W, Su Y, et al. Perinatal risk factors for neonatal early-onset sepsis: a meta-analysis of observational studies[J]. J Matern Fetal Neonatal Med, 2023, 36(2): 2259049.
[15]	Benitz WE, Achten NB. Technical assessment of the neonatal early-onset sepsis risk calculator[J]. Lancet Infect Dis, 2021, 21(5): e134-e140.
[16]	Achten NB, Klingenberg C, Benitz WE, et al. Association of use of the neonatal early-onset sepsis calculator with reduction in antibiotic therapy and safety: a systematic review and meta-analysis[J]. JAMA Pediatr, 2019, 173(11): 1032-1040. doi: 10.1001/jamapediatrics.2019.2825
[17]	Prevention of Group B Streptococcal Early-Onset Disease in Newborns: ACOG Committee Opinion, Number 797[J]. Obstet Gynecol, 2020, 135(2): e51-e72.
[18]	Giannoni E, Dimopoulou V, Klingenberg C, et al. Analysis of antibiotic exposure and early-onset neonatal sepsis in Europe, North America, and Australia[J]. JAMA Netw Open, 2022, 5(11): e2243691.
[19]	Yu Y, Dong Q, Li S, et al. Etiology and clinical characteristics of neonatal sepsis in different medical setting models: A retrospective multi-center study[J]. Front Pediatr, 2022, 10: 1004750.
[20]	Qiu Y, Yang J, Chen Y, et al. Microbiological profiles and antimicrobial resistance patterns of pediatric bloodstream pathogens in China, 2016-2018[J]. Eur J Clin Microbiol Infect Dis, 2021, 40(4): 739-749.
[21]	Dudeja S. Neonatal Sepsis: Treatment of neonatal sepsis in multidrug-resistant (MDR) infections: Part 2[J]. Indian J Pediatr, 2020, 87(2): 122-124. doi: 10.1007/s12098-019-03152-7 pmid: 31900849
[22]	Correction: Towards understanding global patterns of antimicrobial use and resistance in neonatal sepsis: insights from the NeoAMR network[J]. Arch Dis Child, 2020, 105(5): 519. doi: 10.1136/archdischild-2019-316816corr1 pmid: 32220828
[23]	Popescu CR, Cavanagh M, Tembo B, et al. Neonatal sepsis in low-income countries: epidemiology, diagnosis and prevention[J]. Expert Rev Anti Infect Ther, 2020, 18(5): 443-452. doi: 10.1080/14787210.2020.1732818 pmid: 32070161
[24]	Batthula V, Somnath SH, Datta V. Reducing late-onset neonatal sepsis in very low birthweight neonates with central lines in a low-and-middle-income country setting[J]. BMJ Open Qual, 2021, 10(Suppl 1): e001353.
[25]	Zhang HX, Zhao YY, Wang YQ. Analysis of the characteristics of pregnancy and delivery before and after implementation of the two-child policy[J]. Chin Med J (Engl), 2018, 131(1): 37-42.
[26]	Ma Y, Hu M, Zafar Q. Analysis of the impact of external debt on health in an emerging Asian economy: Does FDI matter?[J]. Front Public Health, 2022, 10: 824073.
[27]	Bang A, Deshmukh M, Baitule S, et al. Decline in the incidence of neonatal sepsis in rural gadchiroli, india during the twenty-one years (1998-2019) following the home-based neonatal care field-trial[J]. Pediatr Infect Dis J, 2021, 40(11): 1029-1033.
[28]	Bang A, Baitule S, Deshmukh M, et al. Home-based management of neonatal sepsis: 23 years of sustained implementation and effectiveness in rural Gadchiroli, India, 1996-2019[J]. BMJ Glob Health, 2022, 7(9): e008469.
[29]	Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990-2021: a systematic analysis for the Global Burden of Disease Study 2021[J]. Lancet, 2024, 403(10440): 2100-2132.

项目		1990年			2021年
项目		患病例数	发病例数	死亡例数	患病例数	发病例数	死亡例数
全球		5 187 533.56	5 046 389.04	304 045.32	9 661 523.48	3 880 833.92	232 656.28
美国	女性	53 876.06	16 252.20	419.88	53 017.01	10 888.41	295.02
	男性	61 038.08	21 239.96	523.12	61 772.97	14 434.90	381.40
	合计	114 914.13	37 492.16	943.00	114 789.99	25 323.31	676.43
中国	女性	195 921.32	100 817.14	2 837.51	235 273.93	30 255.82	505.92
	男性	298 338.41	187 697.05	5 198.13	382 036.88	59 099.70	820.14
	合计	494 259.72	288 514.18	8 035.64	617 310.81	89 355.52	1 326.06
印度	女性	267 778.59	396 441.52	28 617.29	795 717.26	253 683.94	15 313.45
	男性	696 800.54	957 359.10	31 370.55	1 820 842.40	604 572.48	17 660.23
	合计	964 579.14	1 353 800.62	59 987.84	2 616 559.66	858 256.42	32 973.68

项目		1990年		2021年		变化率/%
项目		ASPR（/10万）	95%UI	ASPR（/10万）	95%UI	变化率/%
全球		93.55	62.62~138.38	125.86	97.03~156.32	34.5
美国	女性	43.74	27.63~66.11	34.32	26.41~42.79	-21.5
	男性	50.44	32.14~76.87	41.06	31.73~51.43	-18.6
	合计	47.14	29.99~71.46	37.72	29.06~47.19	-20.0
中国	女性	33.99	21.88~51.09	35.99	27.62~45.17	5.9
	男性	47.92	31.48~72.91	56.02	43.03~70.04	16.9
	合计	41.22	26.80~62.38	46.49	35.64~58.14	12.8
印度	女性	59.92	38.73~85.58	115.65	88.81~143.05	93.0
	男性	143.59	91.25~206.32	248.89	192.32~310.08	73.3
	合计	103.42	66.05~148.1	184.33	142.18~228.91	78.2

项目		1990年		2021年		变化率/%
项目		ASIR（/10万）	95%UI	ASIR（/10万）	95%UI	变化率/%
全球		78.98	75.39~84.88	62.70	61.18~64.48	-20.6
美国	女性	16.60	15.82~17.66	12.54	12.08~12.98	-24.5
	男性	20.68	19.71~21.99	15.87	15.30~16.47	-23.3
	合计	18.69	17.90~19.74	14.24	13.84~14.69	-23.8
中国	女性	19.61	18.48~21.11	12.28	11.83~12.71	-37.4
	男性	31.68	29.84~34.00	20.60	19.82~21.38	-35.0
	合计	26.07	24.70~27.75	16.75	16.24~17.30	-35.7
印度	女性	68.82	64.94~73.79	50.88	48.76~53.28	-26.1
	男性	154.49	145.54~167.87	109.81	104.86~114.85	-28.9
	合计	113.22	107.09~122.10	81.80	78.72~84.88	-27.8

项目		1990年		2021年		变化率/%
项目		ASDR（/10万）	95%UI	ASDR（/10万）	95%UI	变化率/%
全球		4.77	4.23~5.31	3.76	3.18~4.40	-21.2
美国	女性	0.43	0.41~0.44	0.34	0.30~0.37	-20.9
	男性	0.51	0.49~0.53	0.42	0.37~0.47	-17.6
	合计	0.47	0.46~0.48	0.38	0.34~0.42	-19.1
中国	女性	0.55	0.44~0.67	0.20	0.14~0.26	-63.6
	男性	0.88	0.67~1.09	0.28	0.21~0.36	-68.2
	合计	0.73	0.59~0.88	0.25	0.18~0.31	-65.8
印度	女性	4.97	4.02~6.19	3.07	2.24~4.15	-38.2
	男性	5.06	4.10~6.28	3.21	2.28~4.32	-36.6
	合计	5.01	4.21~5.97	3.14	2.33~4.10	-37.3

		全球	美国	中国	印度
ASPR	AAPC	0.99	-0.72	0.40	1.87
	95%CI	(0.85~1.14)	(-0.76~-0.67)	(0.30~0.50)	(1.83~1.92)
	P值	<0.01	<0.01	<0.01	<0.01
ASIR	AAPC	-0.73	-0.87	-1.43	-1.04
	95%CI	(-0.80~-0.65)	(-0.90~-0.84)	(-1.50~-1.37)	(-1.06~-1.02)
	P值	<0.01	<0.01	<0.01	<0.01
ASDR	AAPC	-0.76	-0.41	-3.46	-1.46
	95%CI	(-0.81~-0.73)	(-0.52~-0.31)	(-3.55~-3.39)	(-1.56~-1.39)
	P值	<0.01	<0.01	<0.01	<0.01