住院极低出生体重儿细菌感染的影响因素分析

An analysis of clinical influential factors of bacterial infection among very low birth weight infants in hospital

目的分析极低出生体重儿(VLBWI)细菌感染的临床表现,探讨其相关临床影响因素。方法2006年1月至2007年1月出生24h转入新生儿科的VLBWI121例作为研究对象,记录患儿病情变化时的临床表现及实验室检查结果,并通过统计学方法得出其相关临床影响因素。结果住院期间感染43例共68例次,感染发生率为56.2%(68/121)。感染1次者21例,≥2次者22例。确定诊断7例次,临床诊断61例次。其中早发感染(感染发生于生后48～72h)14例次(14/121、11.6%);迟发感染54例次(感染发生于72h后)(54/121、44.6%)。出生体质量<1kg的感染率为90%(9/10),≥1kg感染率为53.2%(59/111)。感染早期临床表现主要为频繁呼吸暂停、喂养不耐受,肤色晦暗或皮肤有花纹并伴低体温,腹胀、体质量不增,呼吸窘迫等。运用Lo-gistic回归模型分析,其中胎膜早破、出生体质量<1kg、胎龄<32周、机械通气、置留胃管等均与早产儿感染有关。结论多因素导致住院VLBWI发生感染,应根据临床特点早期发现、积极治疗。

Objective To explore various manifestations of bacterial infection among very low birth weight infants （VLBWI） in hospital and their associated factors. Methods 121 VLBWI in the Hospital were under study, 43 suffered from bacterial infection at different time of birth, their clinical manifestations and laboratory examinations were analyzed. The correlations were estimated through statistical calculation. Results A total of 68 bacterial infection occurred among 43 infants in hospital with a prevalence of 56.2% （68/121）. During the hospitalization, there were 22 infants with one time infection, 7 infants with more than 2 times of infection. Seven infections with definite diagnoses, sixty-one were diagnosed clinically. Fourteen infections were early-onset （14/121,11.6%）; Fifty-four were late-onset infection （54/121,44.6%）. The early bacterial infection manifestations include frequent apnea, feeding intolerance, ill appearing or mottling skin with hypothermia, abdominal distention, delayed growth, respiratory distress etc. With logistic regression model to analyze clinical data, prolonged rupture of membrane, low birth weight 〈 1 kg, 〈 32 gestational age, mechanical ventilation, tube feeding would cause infection in premature infant. Conclusion Muhicasual origins create infection factors in hospitalized VLBWI. Abnormal clinical signs should be noticed craly and treatment is needed.