| Objective:This paper is to research and analysis clinical performance characteristics,common complications,positivelaboratory results, blood culture and drug susceptibility test results,outcome of therapy and related risk factors of two different types of neonatal sepsis,provide evidence-based support for the treatment of neonatal sepsis.Methods:121neotates,admitted in NICU from June2010to March2013,were recruited in this study.They were divided into two groups,EOS(occurred within3days after birth) and LOS(occurred after3days of life).We made a comparison of clinical relevant factors,clinical symptoms and complications,laboratory examination,blood culture result and drug sensitive test,outcomes between EOS and LOS.Results:1. In this study, a common clinical symptoms of neonatal sepsis can be summarized as fever, jaundice, apnea, poor circulation, poor response, hard swelling, feeding intolerance or bloating. The incidence rate of poor response and bloating or feeding intolerance in late-onset sepsis was higher than that of early-onset sepsis.2. The complications of neonatal sepsis mostly manifested as necrotizing enterocolitis (NEC), purulent meningitis, septic shock, multiple organ failure (MOF) and disseminated intravascular coagulation (DIC). The incidence rate of purulent meningitis was higher in late-onset sepsis than that of early-onset sepsis.3. In early-onset sepsis, abnormal white blood cell count accounting for54.3%, thrombocytopenia accounting for62.86%, increased C-reactive protein (CRP) accounting for65.71%, increased procalcitonin (PCT) accounting for85.71%. In late-onset sepsis, abnormal white blood cell count(44.19%), thrombocytopenia(31.40%), CRP increased (62.79%), PCT increased(91.86%). Except for the higher incidence rate of thrombocytopenia in early-onset sepsis than that in late-onset sepsis, the two different types of sepsis showed no obvious abnormalities in regard to blood routine,CRP and PCT.4.121cases of children with a clinical diagnosis of sepsis performed blood culture examination. Positive blood culture was found in31cases,16cases of which were Gram-positive bacteria,12cases of which were Gram-negative bacteria,3cases of which were fungus. Pathogens (Staphylococcus aureus),3cases of opportunistic pathogens (seven kinds) in28cases. Opportunistic pathogens are the major pathogens of neonatal sepsis and coagulase-negative staphylococci (CNS) is a major pathogen in late-onset sepsis.3cases of fungal positive cases were found in late-onset sepsis. Staphylococcus aureus, CNS, Enterococcus faecalis, group B streptococcus (GBS) were less sensitive to erythromycin, penicillin and more sensitive to vancomycin, linezolid, teicoplanin; Escherichia coli, pneumonia Klebsiella, Acinetobacter spp were less sensitive to ampicillin, more sensitive to imipenem, meropenem. Fungi were sensitive to flucytosine, fluconazole, itraconazole and voriconazole.5. In the121cases of neonatal sepsis after active treatment,96cases were cured,14cases were improved,3cases gave up treatment, eight patients died, the mortality rate was6.61percent. NEC is the leading cause of neonatal sepsis deaths accounting for62.5%of deaths in children with sepsis (5/8).6.121cases of neonatal sepsis, the early-onset35cases,86cases of late-onset. The early-onset sepsis gives priority to full-term children and children with birth weight>2500g; the late-onset sepsis gives priority to preterm children and low birth weight children mainly. The incidence rate of PROM, the proportion of meconium, suffocation and mechanical ventilation is greater in early-onset sepsis group than that in late-onset sepsis.Conclusions:1. There are seven kinds of common clinical symptoms in neonatal sepsis:fever, jaundice, apnea, poor circulation, poor response, hard swelling and bloating or feeding intolerance. For preterm children and low birth weight children who appear poor response,bloating or feeding intolerance should think highly of late-onset sepsis.2. The common complication of neonatal sepsis include by frequency of occurrence: purulent meningitis,NEC,MOF,septic shock and DIC. NEC is an important cause of death in neonatal sepsis, neonatal sepsis and complications, especially the occurrence of NEC should be valued.3. Except for the higher incidence rate of thrombocytopenia in early-onset sepsis than that in late-onset sepsis, the two different types of sepsis showed no obvious abnormalities in regard to blood routine. But CRP and PCT. but the CRP, PCT or CRP+PCT proved to be of practical importance in clinical diagnosis in newborn children with sepsis.4. The positive rate of blood cultures of neonatal sepsis is low, though not as a basis for clinical diagnosis of sepsis, but it has the significant instruction for the use of antibiotics. Opportunistic pathogens become a major pathogen of neonatal sepsis, it is important to control and prevent nosocomial infections. Late-onset sepsis is CNS-based; Long-term hospitalized children should prevent Fungi infection.5. Preterm and low birth weight children should be wary of late-onset sepsis caused by nosocomial infections. Children with premature rupture of membranes, meconium, neonatal asphyxia and mechanical ventilation within3days of birth should be wary of early-onset sepsis. |
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