- 分享 - [](https://www.facebook.com/sharer.php?u=https://about.ebsco.com/zh-tw/markdownify/node/73361) - []() - []() - []() # 實證醫學EBM Focus系列文章：我們能靠醫用風險計算機來治療早發型新生兒敗血症？ 早發型新生兒敗血症計算機能否準確對有敗血症風險的新生兒進行篩檢量表？此篇醫學系列文章可了解編輯團隊對這個臨床工具的看法。 ![nurse tablet outside blog image template ](/sites/default/files/acquiadam-assets/nurse-tablet-outside-blog-image-template-780.jpg) 2021年9月29日 在高達[**18％被感染的新生嬰兒**](https://nam10.safelinks.protection.outlook.com/?url=https%3A%2F%2Fgo.ebsco.com%2FNjg5LUxOUS04NTUAAAF-aTJ1ojECZLY2j-rhxbOyzBVL_RrBo4jP-T-M_cUAQPZ-uZN2-1BvUAiaGUu-wKqEriLKEeM%3D&data=04%7C01%7Chmarshall%40ebsco.com%7C396f9cd1a0d94883145308d94c717922%7C50fa36ca7dd344f19e3f1bf39a3963a5%7C0%7C0%7C637624872509863192%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C1000&sdata=LcahjFeMWTt%2FjTZjVGIaJWCZe3M%2FzXAcMMilZOCj72U%3D&reserved=0)當中，早發型新生兒敗血症(Early-onset neonatal sepsis)通常會造成相當高的罹病率及死亡率；在1990年期間是靠著許多公衛相關人員和醫療照護懷孕患者與其新生兒的臨床醫生們的共同努力才[讓](https://nam10.safelinks.protection.outlook.com/?url=https%3A%2F%2Fgo.ebsco.com%2FNjg5LUxOUS04NTUAAAF-aTJ1oaHKCw1OEIShm08ykDF5qSngF9HD9tHpXZuBCcpo-1Fscfi2G8QIAXKpV9i2eHBeaNU%3D&data=04%7C01%7Chmarshall%40ebsco.com%7C396f9cd1a0d94883145308d94c717922%7C50fa36ca7dd344f19e3f1bf39a3963a5%7C0%7C0%7C637624872509873186%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C1000&sdata=K5mJL0SC3LLkD9asNEsurbit4JayF4%2FmzN96ZChFgws%3D&reserved=0)[**早發型新生兒敗血症明顯降低**](https://nam10.safelinks.protection.outlook.com/?url=https%3A%2F%2Fgo.ebsco.com%2FNjg5LUxOUS04NTUAAAF-aTJ1oaHKCw1OEIShm08ykDF5qSngF9HD9tHpXZuBCcpo-1Fscfi2G8QIAXKpV9i2eHBeaNU%3D&data=04%7C01%7Chmarshall%40ebsco.com%7C396f9cd1a0d94883145308d94c717922%7C50fa36ca7dd344f19e3f1bf39a3963a5%7C0%7C0%7C637624872509873186%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C1000&sdata=K5mJL0SC3LLkD9asNEsurbit4JayF4%2FmzN96ZChFgws%3D&reserved=0)，在足月新生兒當中，其比例更是降到**接近0.1％**；針對這種日漸罕見的病症，為減少可能有的過度檢驗和過度醫療，很多臨床醫生都主張採用**[早發型新生兒敗血症計算機](https://nam10.safelinks.protection.outlook.com/?url=https%3A%2F%2Fgo.ebsco.com%2FNjg5LUxOUS04NTUAAAF-aTJ1ouI4KAZsuhJ2Dp5XRqXrbp8CTqzZ5xuH7i3j3rZ3WNKp_oObKz6seN0IZ3RwJHM1nxI%3D&data=04%7C01%7Chmarshall%40ebsco.com%7C396f9cd1a0d94883145308d94c717922%7C50fa36ca7dd344f19e3f1bf39a3963a5%7C0%7C0%7C637624872509883180%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C1000&sdata=Khvhf%2Fh4mVxY6CtK7wIrD5Qqvn0W%2F97nKPP25soDTGI%3D&reserved=0) (Early-Onset Sepsis Calculator)**，而[**在先前一項試驗與之後的研究，這種計算機已顯示具有效性及安全性**](https://nam10.safelinks.protection.outlook.com/?url=https%3A%2F%2Fgo.ebsco.com%2FNjg5LUxOUS04NTUAAAF-aTJ1ojSz8MbKcJdfJtLUv2reJxkjfahFuWY4cEN8O-mHl30lNkCJ3L_AZB1282eq8jMAF8E%3D&data=04%7C01%7Chmarshall%40ebsco.com%7C396f9cd1a0d94883145308d94c717922%7C50fa36ca7dd344f19e3f1bf39a3963a5%7C0%7C0%7C637624872509883180%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C1000&sdata=o0gFdlyh6wY4%2B7GAn53rfNbzwOf4DvlCF1%2Fi%2F2eoujk%3D&reserved=0)且之前[**發表的一份系統性文獻回顧**](https://nam10.safelinks.protection.outlook.com/?url=https%3A%2F%2Fgo.ebsco.com%2FNjg5LUxOUS04NTUAAAF-aTJ1obkMnGJDihpjy7bnM-46S6gZNDIUXseE6uf83D53oqd6hFkqvd1Hd4qUCHVeDVupN24%3D&data=04%7C01%7Chmarshall%40ebsco.com%7C396f9cd1a0d94883145308d94c717922%7C50fa36ca7dd344f19e3f1bf39a3963a5%7C0%7C0%7C637624872509893180%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C1000&sdata=%2BRgaQmIdBKh439rEQRW3fXaVCShYYYe504pebq7XlB4%3D&reserved=0)也證實，這種計算機可將經驗性抗生素需求的相對風險差(relative risk reduction)降低55％，這似乎也沒有遺漏任何早發型新生兒敗血症個案。 剛出生不久就接觸非必要的抗生素會增加細菌抗藥性，同時還會打亂各種微生物質且與包含像是**氣喘(**[**asthma**](https://nam10.safelinks.protection.outlook.com/?url=https%3A%2F%2Fgo.ebsco.com%2FNjg5LUxOUS04NTUAAAF-aTJ1of3Ba583IKQawcbf-qO3b-jwig6xsbYlZdj5Agq4QSG9q69WnQ5Oiaam3ROEUHpSBhM%3D&data=04%7C01%7Chmarshall%40ebsco.com%7C396f9cd1a0d94883145308d94c717922%7C50fa36ca7dd344f19e3f1bf39a3963a5%7C0%7C0%7C637624872509893180%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C1000&sdata=009%2Fpeov9wfKdEDJF8l5JCZEWGKLHSL6xa3e4ST3%2FUY%3D&reserved=0)**)**在內的其他長期影響有所關聯；過度施加篩檢與監測不但會讓新生兒留院時間拉長，同時增加雙親的焦慮和引起**脆弱孩童症候群(**[**vulnerable**](https://nam10.safelinks.protection.outlook.com/?url=https%3A%2F%2Fgo.ebsco.com%2FNjg5LUxOUS04NTUAAAF-aTJ1oRh3UA9-rkgxYvNCTKy7JDllnGAQWgR_c-XvJhvXH2YWXQXna177jfka6DxFCnqZz9s%3D&data=04%7C01%7Chmarshall%40ebsco.com%7C396f9cd1a0d94883145308d94c717922%7C50fa36ca7dd344f19e3f1bf39a3963a5%7C0%7C0%7C637624872509903173%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C1000&sdata=Uw0xkgnXpFAxycnBJJDsFnMzn4AYoABgNKuHRy%2FnvCk%3D&reserved=0) [**child syndrome**](https://nam10.safelinks.protection.outlook.com/?url=https%3A%2F%2Fgo.ebsco.com%2FNjg5LUxOUS04NTUAAAF-aTJ1oRh3UA9-rkgxYvNCTKy7JDllnGAQWgR_c-XvJhvXH2YWXQXna177jfka6DxFCnqZz9s%3D&data=04%7C01%7Chmarshall%40ebsco.com%7C396f9cd1a0d94883145308d94c717922%7C50fa36ca7dd344f19e3f1bf39a3963a5%7C0%7C0%7C637624872509903173%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C1000&sdata=Uw0xkgnXpFAxycnBJJDsFnMzn4AYoABgNKuHRy%2FnvCk%3D&reserved=0)**)**。Kaiser早發型新生兒敗血症計算機能提供具體“數字”及各種進一步處置建議 — 這可說是一款理想的臨床篩測評量工具，但對於這種臨床決策支援工具能否正確將嬰兒劃分風險量表，這項綜合分析則出現一些質疑，至於這項文獻回顧具有的限制包括大部分被納入的研究都具有高風險偏差且納入已知的早發型新生兒敗血症個案都以回溯方式找出，即使在前瞻性世代資料也有相當多出現早發型新生兒敗血症的嬰兒是在出生及12小時內(分別是40%與23.3%)均建議採用一般常規照護即可；此外關於真陰性數據並未加以報導，因此這款計算機的陰性預測值(negative predictive value, NPV)仍不得而知；據我們推測其陰性預測值(NPV)應相當高，雖不盡完美，但這些數據仍能呈現早發型新生兒敗血症計算機在現實中的運用狀況 — 現實中的臨床決策判斷和各種患者因子都與原始設計截然不同；相信**在嬰兒剛出生的兩天內由相對保守的臨床醫生或許會將這種早發型新生兒敗血症計算機的建議納入考量並同時密切監控各種臨床變化。** 訂閱實證醫學EBM Focus系列電子報 [ 訂閱 EBM Focus ](https://more.ebsco.com/EBM-Focus-Newsletter-Signup.html?_ga=2.144705136.518851193.1640572754-1896165697.1630287859) 類別 : [醫學 ](/zh-tw/blogs/ebscopost/category/醫學) 標籤 : [實證醫學EBM](/zh-tw/blogs/ebscopost/tag/實證醫學ebm) - 分享 - [](https://www.facebook.com/sharer.php?u=https://about.ebsco.com/zh-tw/markdownify/node/73361) - []() - []() - []()