Analysis of clinical features, pathogen distribution and outcome of 229 children with neonatal sepsis / 中华实用儿科临床杂志

ABSTRACT

Objective@#To analyze the clinical features, etiology and outcome of neonatal sepsis, and to clarify the characteristics of early-onset sepsis and late-onset sepsis, which may provide clinical evidence for early diagnosis and treatment of neonatal sepsis.@*Methods@#Two hundred and twenty-nine cases of neonatal sepsis who were hospita-lized in the First Neonatal Wards, Shengjing Hospital Affiliated to China Medical University First Neonatal Wards from June 2013 to June 2016, and according to the onset time, they were divided into the early-onset sepsis (EOS) group and the late-onset sepsis(LOS) group, and SPSS 20.0 statistical software was used for comparative analysis of the data concerning the general situation, clinical manifestation, laboratory examination, pathogen distribution, complications and outcome between 2 groups, and Logistic stepwise regression was used to detect multiple factors.@*Results@#Sixty-eight patients (29.69%) were in the EOS group, and among them the full-term infants with normal weight accounted for 51.5%; 161 cases (70.31%) were in the LOS group with extremely low birth weight premature infants occupying 52.2%.The mothers with gestational hypertension, after the birth of mechanical ventilation, parenteral nutrition(>3 d), indwelling peripherally inserted central catheters (>5 d) had significant correlations with sepsis(all P<0.05). They had fever and jaundice, complicated with purulent meningitis in the EOS group.The apnea and abdominal distension seemed more easily complicated with necrotizing enterocolitis in the LOS group.There as no difference in laboratory test indexes such as platelet, C-reactive protein (CRP) (all P>0.05). Procalcitonin and CRP had higher sensitivity in the diagnosis of sepsis.EOS was given priority to Gram-positive bacteria, which was far more common coagulase negative staphylococcus [26.5%(18/68 cases)], and LOS was due to mainly Gram-negative bacteria and the main pathogens were klebsiella pneumoniae in 86 cases (53.4%). The mortality in the EOS group was significantly higher than that in the LOS group[7.4%(5/68 cases) vs.2.5%(4/161 cases)], but the difference was not statistically significant (χ2=4.72, P>0.05).@*Conclusions@#Because time of neonatal sepsis onset time is different, the clinical characteristics, the distribution of etiology and outcome also show some differences, and full-terms often have EOS which is more common in the premature babies with LOS.There are various high risk factors for sepsis in perinatal and postnatal period.Therefore, early and timely diagnosing the neonatal sepsis has great significance in reducing the mortality of neonatal sepsis.