早发及晚发型新生儿败血症的临床特征分析

目的 回顾性研究早发型败血症(early-onset sepsis,EOS)及晚发型败血症(late-onset sepsis,LOS患儿的临床表现及预后，探讨新生儿败血症的早期诊治措施。方法 回顾性分析2015年1月至2020年12月解放军总医院第五医学中心儿科收治的败血症患儿(血培养均阳性)，根据发病时间分为EOS组(生后≤72 h发病，n=60)、LOS组(生后>72 h发病，n=43)，对EOS组及LOS组患儿基本情况、起病症状、致病菌分布、实验室检测、预后进行分析比较。统计学方法采用t检验、秩和检验、χ²检验。结果 本研究共选入败血症患儿103例(血培养均阳性)，其中EOS组60例(58.2%),LOS组43例(41.7%)。EOS组与LOS组患儿出生时羊水污染发生率[36.7%(22/60)与7.0%(3/43)]、孕母发热率[15.0%(9/60)与2.3%(1/43)]比较，EOS组均高于LOS组(χ²值分别为12.013和4.590, P值均<0.05);LOS组与EOS组患儿中早产儿[79.1%(34/43)与...

Clinical features analysis of early-onset and late-onset neonatal sepsis

Objective To retrospective study the clinical manifestations and prognosis of neonates with early-onset and late-onset sepsis,investigate the early diagnosis and treatment of neonatal septicemia.Method From January 2015 to December 2020,the neonates with sepsis(all blood cultures were positive)were retrospectively analyzed in Pediatric department of the Fifth Medical Center of PLA General Hospital.According to the onset time,they were divided into EOS group(onset≤72 h after birth,n=60)and LOS group(onset>72 h after birth,n=43).The basic condition,onset symptoms,pathogen distribution,laboratory detection and prognosis of EOS group and LOS group were analyzed and compared.Statistical methods performed by t-test,rank sum test andχ²-test.Result A total of 103 cases with sepsis(all blood cultures were positive)were selected in the study,including 60 cases in the EOS group(58.2%)and 43 cases in the LOS group(41.7%).The incidence of amniotic fluid contamination[36.7%(22/60)vs 7.0%(3/43)]and maternal fever[15.0%(9/60)vs 2.3%(1/43)]at birth in EOS group were higher than those in LOS group(χ²=12.013,4.590,P<0.05).The proportion of premature infants[79.1%(34/43)vs 18.3%(11/60)]and low birth weight infants[62.8%(27/43)vs 20.0%(12/60)]in LOS group were higher than those in EOS group(χ²=37.558,19.494,P<0.05).The incidence of dyspnea[51.7%(31/60)vs 16.3%(7/43)]in EOS group was higher than that in LOS group(χ²=13.473,P<0.05).The incidence of apnea[16.3%(7/43)vs 1.7%(1/60)],poor reaction[34.9%(15/43)vs 5.0%(3/60)],abnormal blood glucose[14.0%(6/43)vs 1.7%(1/60)]and skin fluttering[14.0%(6/43)vs 3.3%(2/60)]in LOS group were higher than those in EOS group(χ²=7.466,15.511,5.970,3.944,all P<0.05).The incidence of leukopenia(white blood count<5×10⁹/L)[30.2%(13/43)vs 5.0%(3/60)]in LOS group was significantly higher than that in EOS group(χ²=5.85,P<0.05).Serum levels of CRP and PCT in LOS group were significantly higher than those in EOS group(Z=-2.01,-2.35,P<0.05).In the EOS group,Gram-positive bacteria were the most prevalent,accounting for 40 cases(66.6%),including 14 cases of Staphylococcus epidermidis and 6 cases of Listeria in the top two.In LOS group,Gram-negative bacteria were the most prevalent,accounting for 35 cases(81.3%),with 17 cases of Escherichia coli and 7 cases of Klebsiella pneumoniae in the top two.There was no significant difference in the complications and outcomes of sepsis between the two groups(P>0.05).Conclusion There are some differences between early-onset and late-onset neonatal sepsis.Most cases of EOS are caused by gram-positive bacteria,and most are caused by Staphylococcus epidermidis.Most cases of LOS were infected with gram-negative bacteria,and most are infected with escherichia coli.Amniotic fluid contamination and prenatal fever are high risk factors for EOS,and dyspnea is a common symptom after onset.Distinguishing EOS and LOS can guide rational drug use of neonatal sepsis with unknown pathogenic bacteria.