早发型与晚发型新生儿败血症的临床特点及病原学比较

Clinical characteristics and etiology of early-onset and late-onset neonatal sepsis

目的分析早发型与晚发型新生儿败血症的临床特点及病原学分布,以助于临床早期诊断及治疗。方法分析2017年1月至10月期间苏州市立医院新生儿科收治的28例早发型败血症和31例晚发型败血症新生儿的临床资料。结果晚发型新生儿败血症患儿呼吸暂停、腹胀、心率增快的发生率显著高于早发型患儿,差异有统计学意义(P<0.05);早发型和晚发型新生儿败血症患儿体温异常、进奶减少、黄疸、皮肤脓疱、气促的发生率比较差异均无统计学意义(P>0.05)。晚发型新生儿败血症患儿C反应蛋白升高比例显著大于早发型患儿,差异有统计学意义(P<0.05);早发型和晚发型新生儿败血症患儿白细胞异常、血小板减少的比例比较差异无统计学意义(P>0.05)。早发型中无乳链球菌检出率最高25.00%(7/28),晚发型中肺炎克雷伯菌检出率最高38.71%(12/31)。结论晚发型新生儿败血症的呼吸暂停、腹胀、心率增快症状比早发型败血症更多见,C反应蛋白是早期判断晚发型败血症的重要指标,两型败血症的病原学分布有所差异,临床应酌情选用抗菌药物。

Objective To analyze the clinical characteristics and pathogenic bacteria distribution of early-onset and late-onset neonatal sepsis, in order to aid in the early clinical diagnosis and treatment.Methods From Jan. 2017 to Oct. 2017, 28 cases of early-onset neonatal sepsis and 31 cases of late-onset neonatal sepsis were treated in our hospital, and their clinical data were analyzed.Results The incidence of apnea, abdominal distention and heart rate increase was significantly higher in late-onset group （ P 〈0.05）. There was no statistical difference in the incidence of abnormal body temperature, milk decrease, jaundice, skin empyesis or shortness of breath. Percentage of elevated C-reactive protein in late-onset group was significantly higher than that in early-onset group （ P 〈0.05）. There was no statistical difference in the percentage of abnormal WBC or platelet decrease. Streptococcus agalactiae was detected with the highest frequency in early-onset group（25%,7/28）, while klebsiella pneumonia was the most frequently detected strain in late-onset group（38.71%,12/31）.Conclusion The symptoms of apnea, abdominal distention and heart rate increase are more common in late-onset neonatal sepsis than in early-onset neonatal sepsis. C-reactive protein is an important indicator in early evaluation of late-onset neonatal sepsis. Early-onset and late-onset neonatal sepsis differ in the distribution of pathogenic bacteria. Antibiotics should be used according to actual clinical conditions.