足月新生儿早发感染的危险因素分析

Analysis of risk factors of early-onset neonatal infection in full-term newborns

目的探讨足月新生儿早发感染(early-onset neonatal infection,EONI)的危险因素,为及时发现早发潜在感染、对新生儿进行有效的围产期干预提供参考依据。方法选取2020年10月至2021年11月清华大学附属北京清华长庚医院产科分娩的足月新生儿,根据临床表现或实验室检查结果将其分为感染组和非感染组,比较两组的临床资料,并采用二分类多因素logistic回归分析方法分析导致新生儿发生EONI的危险因素。结果共纳入287例足月新生儿,非感染196例,感染91例,感染发生率为31.7%。感染组的出生胎龄、出生体质量、剖宫产率、CRP和WBC均高于非感染组[39(39,40)周比39(38,40)周,(3423±385)g比(3330±365)g,53.8%比39.3%,14.52(8.68,20.37)mg/L比1.93(0.87,3.32)mg/L,24.37(19.76,31.01)×10^(9)/L比22.32(19.65,25.66)×10^(9)/L],差异均有统计学意义(P<0.05)。感染组母亲产时发热率、分娩前炎症指标增高发生率、胎盘病理提示绒毛膜羊膜炎发生率及妊娠期合并症发生率均高于非感染组(20.9%比3.6%,19.8%比6.1%,28.6%比13.8%,40.7%比27.6%),差异有统计学意义(P<0.05);与非感染组比较,感染组的胎膜早破发生率和产前抗菌药物使用率更低(29.7%比44.9%,47.3%比75.5%),差异有统计学意义(P<0.05)。多因素logistic回归分析显示,母亲产时发热(OR=8.856,95%CI:2.926~26.808,P<0.001)、母亲血炎症指标增高(OR=2.768,95%CI:1.000~7.664,P=0.050)、产前不使用抗菌药物(OR=0.146,95%CI:0.076~0.277,P<0.001)、母亲有妊娠期合并症(OR=2.034,95%CI:1.103~3.752,P=0.023)以及胎龄越大(OR=1.599,95%CI:1.181~2.165,P=0.002)的足月新生儿发生EONI的可能性越大。结论足月新生儿发生EONI与母亲产时发热、血炎症指标增高、产前不使用抗菌药物、有妊娠期合并症、胎龄大等危险因素密切相关,对存在高危因素的足月新生儿应积极进行感染相关指标监测。

Objective To explore the risk factors for early-onset neonatal infection(EONI)in full-term newborns,to timely detect early potential infection and provide reference for effective perinatal intervention for newborns.Methods Fullterm newborns delivered in the Department of Obstetrics Beijing Tsinghua Changgung Hospital,Tsinghua University from October 2020 to November 2021 were selected.According to the clinical manifestations and laboratory examination results,they were divided into in the infected group and the non-infected group.The clinical data of the two groups were compared,and the risk factors for EONI of full-term newborns were analyzed using the method of binary logistic regression analysis.Results A total of 287 full-term newborns were selected,including 196 non-infected newborns and 91 infected newborns,with an infection rate of 31.7%.The gestational age,birth weight,cesarean section rate,CRP and WBC of the infected group were higher than those of the non-infected group[39(39,40)weeks vs.39(38,40)weeks,(3423±385)g vs.(3330±365)g,53.8%vs.39.3%,14.52(8.68,20.37)mg/L vs.1.93(0.87,3.32)mg/L,24.37(19.76,31.01)×10^(9)/L vs.22.32(19.65,25.66)×10^(9)/L],the differences were statistically significant(P<0.05).The incidence of maternal fever at delivery,increased inflammation index before delivery,chorioamnionitis indicated by placental pathology and the incidence of complications during pregnancy in the infected group were all higher than those in the non-infected group(20.9%vs.3.6%,19.8%vs.6.1%,28.6%vs.13.8%,40.7%vs.27.6%),with statistical significance(P<0.06).Compared with the non-infected group,the incidence of premature rupture of membranes and the utilization rate of prenatal antibiotics in the infected group were lower(29.7%vs.44.9%,47.3%vs.75.5%),and the differences were statistically significant(P<0.05).Multivariate logistic regression analysis showed that the possibility of EONI was higher in full-term newborns with maternal fever at delivery(OR=8.856,95%CI:2.926-26.808,P<0.001),increased maternal blood inflammation index(OR=2.768,95%CI:1.000-7.664,P=0.050),no-use of antibiotics before delivery(OR=0.146,95%CI:0.076-0.277,P<0.001),maternal complications during pregnancy(OR=2.034,95%CI:1.103-3.752,P=0.023)and older gestational age(OR=1.599,95%CI:1.181-2.165,P=0.002).Conclusions The occurrence of EONI in full-term newborns is closely related to five leading risk factors,including maternal fever at delivery,increased blood inflammation index,non-use of antibiotics before delivery,pregnancy complications and old gestational age.The infection-related indicators should be actively monitored for full-term newborns with major risk factors.