新生儿败血症298例临床特点分析

目的：探讨新生儿败血症的临床表现、病原菌以及败血症的易感因素及治疗方法。方法回顾性分析2010年1月至2014年12月陕西省人民医院新生儿科收治的298例新生儿败血症患儿的临床诊治资料。结果新生儿败血症的出现症状时间为出生后2~36 d。所有患者均有反应差、喂养不耐受等表现；实验室检查有外周血白细胞计数异常，血小板下降，超敏C反应蛋白和降钙素升高。血培养阳性率为36.2%，常见病原菌为肺炎克雷伯菌(29.6%)、大肠埃希菌(13.9%)、表皮葡萄球菌(13.0%)、铜绿假单胞菌(6.5%)、屎肠球菌(4.6%)。早产儿、低出生体重儿、侵袭性操作、羊水污染、母产前感染性疾病与新生儿败血症发生密切相关。结论新生儿败血症早期临床表现不典型，病原菌以肺炎克雷伯菌为主；早期、足疗程抗感染治疗预后效果较好，治愈率高。

Clinical analysis of 298 cases of neonatal septicemia

Objective To study the clinical characteristics, pathogens and related factors of neonatal septice-mia, and provide evidence for prevention and early treatment. Methods The clinical data of 298 cases of newborns with neonatal septicemia, who admitted to Department of Neonatology of Shaanxi Provincial People's Hospital from Jan-uary 2011 to December 2014 was retrospectively analyzed. Results The onset time of neonatal septicemia was 2 d and 36 d after birth. All of the patients had poor reaction and feeding intolerance. Laboratory tests showed that all the pa-tients had abnormal white blood cell count, increased C-reactive protein (CRP) and procalcitonin (PCT), and decreased thrombocytopenia. The positive blood culture rate was 36.2%. The most common pathogens were Klebsiella pneumoniae (29.6%), Escherichia coli (13.9%), Staphylococcus epidermidis (13.0%), Pseudomonas aeruginosa (6.5%), Enterococcus fae-cium (4.6%). Premature infant, low birth weight infant, invasive medical operation, amniotic fluid pollution were high risk factors of neonatal septicemia. Conclusion Klebsiella pneumoniae is the main pathogen of neonatal septicemias in our hospital. Infection should be prevented and treated during pregnancy. Antibiotics for neonates are limited, so rational administration should be based on the clinical manifestations and antimicrobial susceptibility tests.