Clinical Significance Of Distinguishing Neonatal Septicemia Between Early-Onset And Late-Onset Sepsis

Objective:Analysis the demography, non-specific items, pathogens and antibiotic sensitivity between early onset and late onset septicemia to guide the diagnosis and treatment for neonatal septicemia.Methods:The cases with positive blood culture were retrospectively recruited and divided into early onset and late onset septicemia groups according to the onset time.Results:Of totally 352 cases,144 cases (40.91%) belonged to early onset while 208 cases (59.09%) were late onset, and in late onset group, 108 cases occurred due to nosocomial infection. Most neonates of early onset were term infants[107/144 cases,(74.31%)],while premature[77/20 cases,(37.02%)] and low birth weight[70/208 cases,(33.65%)] accounted for the majority of cases of late onset. Predictors like, asphyxia(χ2=4.622,P<0.05), intrauterine distress(χ2=3.886,P<0.05), meconium-staining amniotic fluid(χ2＝5.950, P<0.05)and premature rupture of fetal membranes>18h(χ2=13.345,P<0.05) occurred more frequently in early onset group while abnormal temperature(χ2=7.853,P<0.05), vomiting or abdominal distention(χ2=66.116,,P<0.05), lethargy(χ2=5.153,P<0.05) and umbilicalitis or skin pustule(x2=5.265,P<0.05) occurred more frequently in late onset group. Besides, more cases in late onset group had elevated I/T ratio[14.67%(27/184)vs 6.77%(9/133),χ2=4.794,P<0.05] and CRP value [36.89%(76/206) vs 26.57%(38/143),χ2=4.087,P<0.05], And patients in late onset group were more likely to get suppurative meningitis (17.33% vs 8.33%; χ2=6.348,P<0.05). In terms of pathogens, the main pathogens in early onset group were gram negative bacteria [39.58%(57/144), including Klebisella pneumoniae in 21cases and E.coli in 20 cases] and coagulase negative staphylococcus[32.64%(47/144)]. In late onset group, the main pathogens were gram positive bacteria[58.65%(122/208)], including coagulase negative staphylococcus in 90 cases(43.27%)] and E.coli [17.79%(37/208)]. There was no significant differences in prognosis between two groups (χ2=1.187, P=0.552)Conclusions:Early onset septicemia and late onset septicemia differ in clinic manifestation and investigation. Distinguishing neonatal early onset and late onset septicemia has some value for choosing the antibiotics.