ABSTRACT
Objective:To investigate the influential factors of neonatal hypoxic ischemic encephalopathy (HIE), and compare the therapeutic effects of mild hypothermia at different time windows and between different degrees of disease severity.Methods:Eighty-two neonates with HIE who were admitted to Jiaxing Maternity and Child Health Care Hospital from January 2016 to October 2021 were included in the patient group, and 123 concurrent healthy neonates were included in the control group. The influential factors of neonatal HIE were analyzed. Sixty-five neonates who received HIE were divided into four groups according to the time length between symptom onset and hospital admission (< 6 hours and 6-12 hours) and disease severity: group I (admission time < 6 hours, mild, n = 20), group II (admission time < 6 hours, moderate to severe, n = 15), group III (admission time 6-12 hours, mild, n = 17), and group IV (admission time 6-12 hours, moderate to severe, n = 13). Amplitude-integrated electroencephalography (aGGE) score was used as the evaluation criteria. The therapeutic effects of mild hypothermia were compared between different time windows and between different degrees of HIE. Results:Multivariable logistic regression analysis results revealed that the influential factors of neonatal HIE included gestational hypertension, gestational diabetes, pregnancy examination, delivery methods, amniotic fluid contamination, abnormal fetal membranes (placenta or umbilical cord), fetal distress, and neonatal asphyxia ( P < 0.05). All 65 neonates with HIE underwent mild hypothermia treatment for 72 hours. Before treatment, aGGE score in groups I, II, III and IV was 6.02 ± 1.74 points, 2.43 ± 1.82 points, 5.23 ± 1.95 points, and 2.72 ± 1.76 points, respectively. After treatment, it was 8.13 ± 2.03 points, 6.47 ± 1.87 points, 7.86 ± 1.92 points, and 3.52 ± 1.95 points, respectively. There was significant difference in aGGE score between before and after treatment in groups I, II and III ( t = 2.87, 3.55, 3.15, all P < 0.05). aGGE score in group IV did not differ significantly between before and after treatment ( P > 0.05). Before treatment, aGGE score in children with moderate to severe HIE was lower than that in children with mild HIE. After treatment, there was no significant difference in aGGE score between groups II and III ( P > 0.05). Conclusion:Pregnant women with gestational hypertension and gestational diabetes should be given intensive monitoring and learn HIE related knowledge to increase the frequency of prenatal examinations. If amniotic fluid contamination, abnormal fetal membranes (placenta or umbilical cord), fetal distress, or neonatal asphyxia occurs, timely monitoring and corresponding interventions should be given to the fetus. Mild hypothermia therapy has a certain therapeutic effect on different degrees of HIE. For moderate to severe neonates, treatment should be started within 6 hours to ensure the therapeutic effects of mild hypothermia.
ABSTRACT
Objective To study the distribution and drug resistance of pathogens in neonatal septicemia in order to provide clinical guidance for antibiotic usage.Methods This retrospective study analyzed blood culture and clinical data from 83 confirmed neonatal septicemia patients and the blood collection cultures were analyzed.Results A total of 84 strains were isolated from 83 cases of blood specimens,Gram positive bacteria,Gram negative bacteria and fungi were 38(45.2%),41(48.8%),5(6.0%),respectively.Gram positive bacteria was mainly coagulase negative staphylococcus and staphylococcus aureus,which were 13(15.5%) and 8(9.5%) respectively.Gram negative bacteria was mainly Escherichia coli and Klebsiella pneumonia,which were 25(29.8%) and 9(10.7%) respectively.Gram positive bacteria were found high resistance to penicillin G,amoxicillin clavulanate potassium,oxacillin and clindamycin,from 34.2% to 73.7%,but they were sensitive to vancomycin,teicoplanin and linezolid.Gram negative bacteria were found high resistance to ampicillin(82.9%),the constituent ratio of the extended spectrum βlactamases(ESBLs) was 34.1%,carbapenem resistant strains was not found.All fungi were sensitive to azoles.Conclusion Gram negative bacteria are the major pathogens in neonatal septicemia,with high infection rate of Escherichia coli and high constituent ratio of the ESBLs,and antimicrobial agents should be chosen according to blood culture and antimicrobial susceptibility results.