临床儿科杂志 ›› 2017, Vol. 35 ›› Issue (3): 166-.doi: 10.3969/j.issn.1000-3606.2017.03.002

• 围产新生儿疾病专栏 • 上一篇    下一篇

新生儿坏死性肺炎2 例报告并文献复习

张可, 周建国, 胡兰, 邓英平, 陈超   

  1. 复旦大学附属儿科医院(上海 201102)
  • 收稿日期:2017-03-15 出版日期:2017-03-15 发布日期:2017-03-15
  • 通讯作者: 陈超 E-mail:chen6010@163 .com

Neonatal necrotizing pneumonia: two case report and literature review

 ZHANG Ke, ZHOU Jianguo, HU Lan, DENG Yingping, CHEN Chao   

  1. Department of Neonatology, Children’s Hospital of Fudan University, Shanghai 201102, China
  • Received:2017-03-15 Online:2017-03-15 Published:2017-03-15

摘要: 目的 分析新生儿坏死性肺炎的临床特点及诊治。方法 回顾分析2例新生儿坏死性肺炎患儿的临床资料, 并总结文献报道。结果 2例新生儿均确诊为社区获得性金黄色葡萄球菌致坏死性肺炎,以发热起病,胸片示渗出性改变 伴囊性影,CT示为多发空洞改变,痰/血培养均为金黄色葡萄球菌阳性,万古霉素治疗有效,影像学检查随访示好转。通 过数据库检索,共有4篇病例报道,加上本组2例共7例新生儿坏死性肺炎病例。致病菌均有金黄色葡萄球菌,其中1例合 并有铜绿假单胞菌, 6例为社区获得性感染,均发生于无免疫缺陷新生儿, 6例为原发性坏死性肺炎, 6例为单侧肺受累; 5 例有发热表现, 5例合并败血症,分别有3例、 2例、 1例并发胸腔积液、气胸或支气管胸膜瘘, 2例有肺外感染; C反应蛋白 均明显升高; 3例需要机械通气, 6例预后良好。结论 新生儿坏死性肺炎以金黄色葡萄球菌为主要致病菌,诊断主要依靠 典型影像学和病原学检查,治疗主要选择针对革兰阳性球菌的抗生素。

Abstract: Objective To explore the clinical features, diagnosis, and treatment of neonatal necrotizing pneumonia. Methods The clinical data of two cases of neonatal necrotizing pneumonia were retrospectively analyzed. The clinical features, diagnosis, and treatment of neonatal necrotizing pneumonia in literatures were summarized. Results Two cases were diagnosed of community-acquired Staphylococcus aureus necrotizing pneumonia and had the  onset with fever. The chest X-ray showed exudative change with cystic shadow. The chest CT showed multiple cavity changes. The sputum and blood cultures were positive for Staphylococcus aureus. Both of them were effectively treated by vancomycin. The imaging was improved during the follow-up. Searching the database, 4 related literatures were being found, and there were totally 7 cases of neonatal necrotizing pneumonia including current 2 cases. The main features were as follows: The pathogenic bacteria in all cases include Staphylococcus aureus. One case was combined with pseudomonas aeruginosa. Six cases were community-acquired infections. All of them were non-immune deficiency newborn. Six cases were primary necrotizing pneumonia. Six cases were unilateral lung involvement. Five cases got fever, 5 cases had septicemia, 3 cases had pleural effusion, 2 cases had aerothorax, one case had bronchial chest and 2 cases had extrapulmonary infection. The C-reactive protein was increased in all cases. Three cases need mechanical ventilation. Six cases had a good prognosis. Conclusions The main pathogenic bacterium in neonatal necrotizing pneumonia was Staphylococcus aureus. The diagnosis was mainly depends on the typical imaging and pathogenic examination. The treatment is mainly the use of antibiotic for gram positive cocci.