Neonatal capillary leak syndrome: analysis of 68 cases / 中华围产医学杂志

Objective@#To analyze clinical features, treatment, prognosis and risk factors for death of capillary leak syndrome (CLS) in neonates.@*Methods@#This retrospective study involved 68 neonates with CLS treated in the Department of Neonatology, Women and Children's Hospital, School of Medicine, Xiamen University from January 2013 to December 2017. Clinical data, including features, causes, treatment and outcomes of those CLS cases were analyzed. Chi-square test and multivariate logistic regression analysis were performed.@*Results@#Among the 68 cases consisting of 49 males and 19 females, 86.7% (59/68) were born at ≥ 35 gestational weeks. Fifty-three neonates (77.9%) developed symptoms within three days after admission. Forty-two cases (61.8%) had respiratory distress syndrome and 35 (51.5%) had septicemia. The mortality rate was 23.5% (16/68). Among the survivors, 38.5% (20/52) showed abnormal cranial MRI. Univariate analysis with Chi-square test showed that neonatal death due to CLS was associated with the lactic acid level >10 mmol/L, oliguria lasting for 12 h or anuria for 8 h, no negative fluid balance occured within seven days, adrenaline infusion >0.6 μg/(kg·min) and administration of 3% sodium chloride. Multivariate logistic regression analysis showed that lactic acid level, oliguria/anuria duration and the time achieve negative fluid balance were independent risk factors for neonatal death of CLS.@*Conclusions@#Neonatal CLS is a condition with high fatality rate and poor prognosis. Respiratory distress syndrome and septicemia are the common causes. The prognosis of CLS might be improved by treatment with 3% sodium chloride. Lactic acid level, oliguria/anuria duration and the time achieve negative fluid balance are independent risk factors for neonatal death due to CLS.

Effects of antenatal antibiotic exposure on clinical characteristics and pathogen distribution in neonatal early-onset sepsis / 中华围产医学杂志

ObjectiveTo investigate the incidence and pathogen distribution of neonatal early-onset sepsis (EOS) following exposure to antenatal antibiotics.MethodsOne hundred and eighty-four neonates who were admitted to Maternal and Child Care Hospital of Xiamen and identified as having EOS from January 2010 to December 2015 were enrolled. The clinical data were retrospectively analyzed. According to antenatal antibiotic exposure time, the infants were divided into the antibiotics group (≥4 hours) and the control group (0.05). Compared with the no-screening group, the positive rate of GBS decreased [7.6% (5/66) vs 18.6% (22/118)] and the positive rate of fungal infection increased [7.6%(5/66) vs 1.7% (2/118)] in the screening group (χ2=4.141,P=0.042;χ2=4.000,P=0.046). The distribution of other pathogenic bacteria such as coagulase-negativeStaphylococci andE. coli was not significantly different between the two groups (P>0.05, respectively). Drug resistance rates ofStaphylococcus (Staphylococcus aureus and coagulase-negativeStaphylococcus) to oxacillin and piperacillin-sulbactam were higher in the screening group than in the no-screening group [82.6% (19/23) vs 52.9% (18/34),χ2=5.302; 78.3% (18/23) vs 47.1% (16/34),χ2=5.549; bothP<0.05], and no vancomycin resistant bacterial strains were found.ConclusionsAntenatal antibiotic exposure may be effective in reducing the occurrence of prematurity, asphyxia,and GBS infection, but it increases the rate of fungal infection, and is not effective in reducing the incidence of complications and mortality or in changing the distribution of the other pathogens in EOS. Rational indications and timing of antenatal antibiotic exposure should be taken into consideration to reduce drug resistance.

Serum procalcitonin in different periods for diagnosis of early-onset of neonatal bacterial infection / 中国小儿急救医学

Objective To evaluate the value of procalcitonin(PCT)in different periods for diagno-sis of early-onset of neonatal bacterial infection.Methods One hundred and ninety-five newborns with intra-uterine infection risk factors were divided into two groups:infection group(24cases)and non-infection group(171cases).The levels of PCT,C-reactive protein(CRP)and WBC were measured in 2hours,6to 12hours,12to 36hours and more than 48hours after birth.The sensitivity and specificity of PCT in different periods in the diagnosis of early-onset infection were analyzed.Results There were no significant differ-ences in the positive rate of PCT,CRP and WBC in infection group in 2hours after birth(P﹥0.05).The sensitivity and specificity for diagnosis of early-onset infection of PCT were 91.7% and 86.5% at 6to 12hours after birth,which were higher than those of CRP and WBC.After birth in 12to 36hours was the physiologic peak of PCT,so it couldn′t have higher sensitivity and specificity.According to threshold of 0.5ng/ml,2ng/ml,and 10ng/ml for PCT,the sensitivity was 100%,91.7% and 100% respectively,and the specificity was 5.8%,53.8%and 95.9%respectively.Conclusion PCT in 6to12hours after birth,ac-cording to threshold of 2ng/ml,can reach higher sensitivity and specificity for diagnosis of early-onset neo-natal bacterial infection.

Relationship between group BStreptococcus colonization in late pregnancies and neonatal infection / 中华围产医学杂志

ObjectiveTo study the effects of group BStreptococcus (GBS) colonization in late pregnancies on neonatal GBS infection.MethodsA total of 17 019 pregnant women who received antenatal care and delivered in Xiamen Maternal and Child Care Hospital from June 1, 2014 to May 31, 2015 were enrolled in this study. Secretions from the lower third of the vagina in the pregnant women at 35-37 weeks of gestation or having premature baby(regardless of gestational age) were obtained to test GBS by standard bacterial culture, and 1 472 cases underwent GBS DNA test by real-time fluorescent quantitative-polymerase chain reaction (PCR) meanwhile. The pregnant women colonized with GBS (GBS culture and/or PCR DNA test positive) were given intrapartum antibiotic prophylaxis (IAP) during parturition or rupture of fetal membranes. Detection rate of the two methods was compared, and the effects of GBS colonization and IAP on neonatal GBS infection were analyzed to identify the risk factors of neonatal early-onset GBS disease (GBS-EOD). Two independent samplest-test,Chi-square test and Logistic regression analysis were used for statistical analysis. ResultsThe detection rate of GBS culture and PCR DNA test was 14.43% (2 456/17 019) and 14.13%(288/1 472), respectively. The total colonization rate was 14.52%(2 472/17 019). Based on the culture results as golden criteria, the sensitivity, specificity, positive predictive value and negative predictive value of PCR assay were 95.05%, 98.74%, 92.31% and 99.21%, respectively. There were 17 332 deliveries from the 17 019 pregnant women, of which 31 cases had GBS-EOD. The incidence of neonatal GBS-EOD in maternal GBS colonization [1.05%(26/2 472)] was 31 times higher than in pregnant women without GBS colonization [0.34‰(5/14 547)]. Among the 31 infants with GBS-EOD, 24 had pneumonia, five had sepsis, and two had meningitis. The case fatality rate was 6.45%(2/31). Logistic regression analysis found that chorioamnionitis was an independent risk factor of neonatal GBS-EOD (OR=40.425, 95%CI: 7.514-379.782,P=0.000). Compared with the non-IAP group,IAP group had a lower incidence of GBS-EOD among the pregnant women colonized with GBS [0.94%(23/2 443) vs 10.34%(3/29),χ2=24.350,P<0.01].ConclusionsGBS colonization in late pregnant women has adverse effects. Therefore, routine maternal rectovaginal culture of GBS may be necessary and IAP should be applied in those with GBS colonization.

Clinical and etiological characteristics of the ventilator-associated pneumonia in newborns / 中国综合临床

Objective To investigate the clinical and etiologic characteristics and drug-resistance features of ventilator-associated pneumonia(VAP)in neonatal intensive care unit.Methods A retrospective study was conducted in 712 newborns with VAP who were admitted to the NICU from January 2007 to December 2010 and had received mechanical ventilation.The pathogenic bacteria spectrum of hospital infection were statistically analyzed.Results VAP was occurred in 69 out of 712 newborns with mechanical ventilation (incidence rate of 9.7％).The top four pathogens were saccharomyces albicans(39.2％),stenotrophomonas maltophilia(20.3％),staphylococcus epidermidis(13.5％)and klebsiella pneumoniae(9.5％),respectively.Conclusion Implementing strict measures to control the nosocomial infection can significantly reduce the incidence of VAP.Saccharomyces albicans,stenotrophomonas maltophilia,staphylococcus epidermidis and klebsiella pneumoniae were the pathogens most commonly involved.