不同类型新生儿败血症的临床特征分析

The clinical characteristic analysis of different types of neonatal septicemia

目的探讨本地早发型新生儿败血症（EONS）与晚发型新生儿败血症（EONS）的临床特征、病原菌分布情况。为早期诊断及治疗提供指导。方法回顾性分析深圳市儿童医院普外科新生儿病区及NICU2008年6月～2013年7月133例新生儿败血症患儿的临床资料、血常规结果及血培养结果。按发病时间分为EONS组及LONS组，比较两组临床特征的异同。结果EONS组的出生胎龄、体重大于LONS组，早产儿、低出生体重儿发生率低于LONS组，胎膜早破、羊水污染发生率高于LONS组，差异有统计学意义（P〈0．05）。EONS组的呼吸暂停、喂养不耐受、化脓性脑膜炎、坏死性小肠结肠炎、血小板减少发生率低于LONS组，感染性休克发生率高于LONS组，差异有统计学意义（P〈0．05）。LONS组主要致病菌为凝血酶阴性葡萄球菌、大肠埃希菌和肺炎克雷伯菌，EONS组主要致病茵为肺炎克雷伯菌、大肠埃希菌及B族溶血性链球菌。结论LONS多发生于早产儿及低出生体重儿，EONS多发生于伴有胎膜早破、羊水污染的足月儿；两组败血症患儿在临床表现、实验室检查及病原菌方面存在一定差异，根据不同特点可指导临床早期诊断和治疗。

Objective To study the clinical characteristic and causative pathogens of early-onset neonatal sepsis（EONS） and late-onset sepsis neonatal （LONS）in order to provide guidance for early diagnosis and treatment. Methods Clinical data,results of blood and blood culture results of 133 neonates of neonatology department in Shenzhen children＇s hospi- tal from June 2008 to July 2013 were retrospectively analyzed.All patients were divided into EONS group and LONS group according to the onset time.Clinical feature of two groups was compared. Results Gestational age,gestational weight of EONS group was larger than that of LONS group respectively,the incidence rate of preterm children and low birth weight children in EONS group was lower than that in LONS group respectively,the incidence rate of premature rupture of membranes and amniotic fluid contamination in EONS group was higher than that in LONS group respec- tively,with statistical difference（P〈0.05）.The incidence rate of apnea,feeding intolerance,fester sex meningitis,necrotizing enterocolitis,thrombocytopenia in EONS group was lower than that in LONS group respectively,the incidence of septic shock in EONS group was higher than that in LONS group,with statistical difference （P〈0.05）.The most common pathogens bacteria in LONS group were Coagulase-negative staphylococcus,Escherichia coli and Klebsiella pneumonia, but the major pathogens bacteria in EONS group were Escherichia coli,Klebsiella pneumonia and Group B Streptococci. Conclusion LONS usually occurs in premature and low birth weight infants,EONS occurs in full-term infants in pa- tients with premature rupture of membranes,amniotic fluid contamination.Two groups of children with septicemia have difference in bacteria and pathogenic clinical manifestation,laboratory examination.It can guide the early clinical diag- nosis and treatment according to the different characteristics.