新生儿晚发败血症的危险因素及临床特征

Risk factors and clinical characteristics of late-onset septicemia in neonates

目的探讨新生儿晚发败血症(late-onset septicemia,LOS)的相关危险因素、临床特征及病原菌,以利于指导临床诊断及治疗。方法收集安徽医科大学附属巢湖医院新生儿科2015年1月—2020年2月收治的诊断为LOS的新生儿,设为观察组;选择同期出生住院未发生败血症的新生儿,设为对照组。分析两组患儿的一般情况、危险因素等,并对LOS患儿的临床表现、并发症及病原菌进行分析。结果共纳入新生儿182例,每组各91例。两组在机械通气、经外周静脉置入中心静脉导管置管、肠外营养、气管插管、新生儿窒息、胎龄<37周、出生体重<2.0 kg方面比较,差异均有统计学意义(P<0.05)。Logistic回归分析显示,胎龄<37周[比值比(odds ratio,OR)=3.010,95%置信区间(confidence interval,CI)(1.489,6.085),P=0.002]、肠外营养[OR=3.506,95%CI(1.681,7.312),P=0.001]是LOS的独立危险因素。LOS的临床表现主要以体温异常、喂养困难、黄疸、呼吸暂停、超敏C反应蛋白增高、降钙素原增高为主;易并发坏死性小肠结肠炎、化脓性脑膜炎。LOS患儿共培养出74株病原菌,包括革兰阳性菌49株、革兰阴性菌21株、真菌4株。危重及死亡病例主要为革兰阴性菌感染。结论引发新生儿LOS的危险因素多样,其中胎龄<37周、肠外营养是LOS的独立危险因素。为避免LOS发生,应注重预防,加强无菌观念,合理使用药物。

Objective To explore the risk factors,clinical characteristics and pathogenic bacteria of late-onset septicemia(LOS)in neonates,so as to guide clinical diagnosis and treatment.Methods Collect LOS in neonates admitted to the Department of Pediatrics,Chaohu Hospital of Anhui Medical University between January 2015 and February 2020,and set them as the observation group.The neonates born at the same time and hospitalized without septicemia were selected as the control group.The general situation and risk factors of the two groups of neonates were analyzed,and the clinical manifestations,complications and pathogenic bacteria of LOS in neonates were analyzed.Results 182 neonates were enrolled,91 in each group.There were significant differences between the two groups in mechanical ventilation,indwelling peripherally inserted central catheter,parenteral nutrition,tracheal intubation,neonatal asphyxia,gestational age<37 weeks,birth weight<2.0 kg(P<0.05).Logistic regression analysis showed that gestational age<37 weeks[odds ratio(OR)=3.010,95%confidence interval(CI)(1.489,6.085),P=0.002],parenteral nutrition[OR=3.506,95%CI(1.681,7.312),P=0.001]were independent risk factors for LOS.The main clinical manifestations of LOS were abnormal temperature,feeding difficulties,jaundice,apnea,hypersensitive C-reactive protein and procalcitonin increase.The neonates with LOS were prone to necrotizing enterocolitis and purulent meningitis.A total of 74 pathogenic bacteria were cultured from neonates with LOS,including 49 Gram-positive bacterium,21 Gramnegative bacteria and 4 fungi.The critical and death cases were mainly infected by Gram-negative bacteria.Conclusions A number of factors are related to LOS.Gestational age<37 weeks and parenteral nutrition are independent risk factors for LOS.In order to avoid LOS,attention should be paid to prevention,aseptic concept should be strengthened,and drugs should be used reasonably.