Sepsis and Critical Illness in Babies > 34 Weeks Gestation

妊娠 34 周以上婴儿的败血症和危重疾病

基本信息

批准号：
7474017
负责人：
GABRIEL J. ESCOBAR
金额：
$ 42.43万
依托单位：
KAISER FOUNDATION RESEARCH INSTITUTE
依托单位国家：
美国
项目类别：
财政年份：
2006
资助国家：
美国
起止时间：
2006-09-30 至 2011-08-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/7474017
关键词：
Address Age Ambulances Antibiotic Therapy Antibiotics Bacterial Infections Biometry Birth Blood Blood gas Boston California Caring Cerebrospinal Fluid Chest Clinical Collaborations Communicable Diseases Complete Blood Count Critical Illness Cross-Sectional Studies Data Deterioration Development Diagnostic tests Electronics Environmental air flow Epidemiology Epidural Anesthesia Evaluation Extracorporeal Membrane Oxygenation Federal Government Frequencies Funding Gestational Age Goals Healthy People 2010 Helicopter Hospitals Hour Infant Infant Mortality Infection Infection of amniotic sac and membranes Joints Laboratories Life Literature Live Birth Maternal and Child Health Medical Medicine Meningitis Modeling Morbidity - disease rate Neonatal Neonatal Intensive Care Units Neonatology Nested Case-Control Study Newborn Infant Paper Patient observation Population Pre-Eclampsia Pregnancy Probability Process Recommendation Records Research Research Personnel Respiratory Failure Respiratory distress Risk Risk Factors Sampling San Francisco Sepsis Shock Symptoms Testing Textbooks Triage Universities Week Work Yin base case control design early onset improved inhaled nitric oxide neutrophil programs tertiary care

项目摘要

DESCRIPTION (provided by applicant): Confirmed neonatal bacterial infections occur in 1-5 per 1000 live births. However, in the US about 10-20 percent of newborns have "sepsis work-ups" done, and 4-10 percent receives systemic antibiotics. Textbooks recommend antibiotic therapy for infants with definite signs of sepsis, meningitis, shock, or respiratory failure. They do not provide evidence-based guidance for the evaluation and management of two common groups of term or near-term newborns: 1) infants with maternal risk factors for bacterial infection (e.g., chorioamnionitis) with no symptoms or who have presentations that are considered equivocal, and 2) infants with respiratory distress, which occurs in approximately 2-3 percent of term and near-term infants. Clinicians evaluating term or near term infants must make 3 decisions: 1) whether to obtain laboratory tests; 2) whether to treat with antibiotics, and 3) whether to transfer the infant to a tertiary care center. We propose to improve the evaluation and management of newborns >= 34 weeks gestation at risk for bacterial infection and/or critical illness by developing an evidence-based approach to estimating probabilities relevant to each of these decisions. We will integrate gestational age-specific prior probabilities with likelihood ratios for maternal risk factors, clinical signs, and age-specific laboratory results. To achieve this goal, we have these Specific Aims: 1) To perform a nested case-control study to quantify maternal and infant clinical risk factors for early onset bacterial infection; 2) To perform a retrospective cross-sectional study to estimate likelihood ratios for early onset bacterial infection for components of the complete blood count (CBC, the most common diagnostic test in this setting), using data from more than 40,000 CBCs and blood cultures from 14 hospitals; and (3) To perform a nested case control study to develop a quantitative model to estimate the probability of newborns >= 34 weeks gestation developing a critical illness (defined by life-threatening arterial blood gas results) based on clinical findings and the results of laboratory tests, including arterial blood gases. To achieve these aims, we will analyze paper and electronic records from 340,000 newborns >= 34 weeks gestation born from 1998 to 2005 at 14 hospitals in Northern California and Boston. Our project builds on considerable development work conducted by investigators at Kaiser Permanente's Division of Research, the University of California, San Francisco, and the Harvard Newborn Medicine Program.

描述（由申请人提供）：每 1000 名活产儿中就有 1-5 人发生确诊的新生儿细菌感染。然而，在美国，大约 10-20% 的新生儿接受了“脓毒症检查”，4-10% 接受全身抗生素治疗。教科书建议对有败血症、脑膜炎、休克或呼吸衰竭明确症状的婴儿进行抗生素治疗。它们没有为评估和管理两个常见的足月或近足月新生儿群体提供基于证据的指导：1）具有细菌感染母体危险因素（例如绒毛膜羊膜炎）但没有症状或有被考虑的表现的婴儿模棱两可，2) 患有呼吸窘迫的婴儿，这种情况发生在大约 2-3% 的足月和近足月婴儿中。评估足月或近足月婴儿的临床医生必须做出 3 个决定：1）是否进行实验室检查； 2) 是否使用抗生素治疗，以及 3) 是否将婴儿转至三级护理中心。我们建议通过开发基于证据的方法来估计与每个决策相关的概率，从而改善对妊娠 34 周以上有细菌感染和/或危重疾病风险的新生儿的评估和管理。我们将把特定孕龄先验概率与孕产妇危险因素、临床体征和特定年龄实验室结果的似然比相结合。为了实现这一目标，我们有以下具体目标： 1）进行巢式病例对照研究，量化母婴早发细菌感染的临床危险因素； 2) 进行一项回顾性横断面研究，使用来自 40,000 多个 CBC 和血培养的数据来估计全血细胞计数（CBC，这种情况下最常见的诊断测试）各组成部分的早发细菌感染的可能性比。 14家医院； (3) 进行巢式病例对照研究，建立定量模型，根据临床发现和以下结果估计妊娠 34 周以上的新生儿患危重疾病（由危及生命的动脉血气结果定义）的概率实验室检查，包括动脉血气分析。为了实现这些目标，我们将分析 1998 年至 2005 年在北加州和波士顿 14 家医院出生的 340,000 名妊娠 34 周以上的新生儿的纸质和电子记录。我们的项目建立在凯撒医疗机构研究部、加州大学旧金山分校和哈佛新生儿医学项目的研究人员进行的大量开发工作的基础上。

项目成果

期刊论文数量（6）

专著数量（0）

科研奖励数量（0）

会议论文数量（0）

专利数量（0）

Interpreting complete blood counts soon after birth in newborns at risk for sepsis.

解读有败血症风险的新生儿出生后不久的全血细胞计数。

DOI：
发表时间：
2010-11
期刊：
影响因子：
8
作者：
Newman, Thomas B;Puopolo, Karen M;Wi, Soora;Draper, David;Escobar, Gabriel J
通讯作者：
Escobar, Gabriel J

Estimating the probability of neonatal early-onset infection on the basis of maternal risk factors.

根据孕产妇危险因素估计新生儿早发型感染的概率。

DOI：
发表时间：
2011-11
期刊：
影响因子：
8
作者：
Puopolo, Karen M;Draper, David;Wi, Soora;Newman, Thomas B;Zupancic, John;Lieberman, Ellice;Smith, Myesha;Escobar, Gabriel J
通讯作者：
Escobar, Gabriel J

Combining immature and total neutrophil counts to predict early onset sepsis in term and late preterm newborns: use of the I/T2.

结合未成熟和总中性粒细胞计数来预测足月和晚期早产新生儿早发败血症：使用 I/T2。

DOI：
发表时间：
2014-08
期刊：
影响因子：
0
作者：
Newman, Thomas B;Draper, David;Puopolo, Karen M;Wi, Soora;Escobar, Gabriel J
通讯作者：
Escobar, Gabriel J

Stratification of risk of early-onset sepsis in newborns ≥ 34 weeks' gestation.

妊娠 34 周新生儿早发败血症风险分层。

DOI：
发表时间：
2014-01
期刊：
影响因子：
8
作者：
Escobar, Gabriel J;Puopolo, Karen M;Wi, Soora;Turk, Benjamin J;Kuzniewicz, Michael W;Walsh, Eileen M;Newman, Thomas B;Zupancic, John;Lieberman, Ellice;Draper, David
通讯作者：
Draper, David

Early-onset sepsis: a predictive model based on maternal risk factors.

早发性败血症：基于孕产妇危险因素的预测模型。