Analysis Of Late-onset Sepsis And Risk Factors In Very Low Birth Weight Infants

ObjectiveWith the development of neonatal diagnosis and treatment technology,the survival rate of very low birth weight infants has showed great improvement,but the morbidity and mortality rate of late-onset sepsis have always been very high,which seriously endanger the quality of life of children patients.This paper studied the clinical characteristics of late-onset sepsis in very low birth weight infants,the high risk factors for the occurrence of late-onset sepsis and their pathogens,so as to provide guidance for early identification and intervention treatment.MethodsFrom January 2013 to December 2017,47 cases of very low birth weight infants who were collected and diagnosed as late-onset sepsis(LOS)positive in the blood culture in the neonatal intensive care unit of Central Hospital of Zibo were selected as the LOS group.And 243 cases of very low birth weight infants who were hospitalized at the same period without sepsis were selected as the control group.Case-control study method was adopted to retrospectively analyze the children patients’ gender,gestational age,birth weight,mode of delivery,Apgar score,amniotic fluid nature,the time of premature rupture of fetal membranes,mother antibiotics use,twins and above,prenatal hormone use,and intrauterine fetal distress,hypertensive disorder complicating pregnancy,peripherally inserted central venous catheters,absolutely parenteral nutrition time,mechanical ventilation,breastfeeding,total parenteral nutrition time,small for gestational age,children patient antibiotics application,a total of 19 indexes and their complications and outcome situation.SPSS 19.0 statistical software was used to respectively conduct single factor logistic regression analysis and multi-factor logistic regression analysis.The pathogens of late-onset sepsis were also analyzed.Results1.Of the 290 cases of very low birth weight infants,47 children patients were diagnosed with LOS,The incidence rate of LOS was 16.21%(47/290).In the LOS group,10 children patients died,with a mortality rate of 21.28%(10/47);in the control group,21 children patients died,with a mortality rate of 8.64%(21/243).The difference between the two groups has statistical significance(P=0.003).The hospital stay in the LOS group was(34.362±8.537)days,and the hospital stay in the control group was 20.752±7.919 days.Late-onset sepsis significantly prolonged hospital stay(P<0.01).2.The incidence of bacterial meningitis with LOS was 23%(11/47),the incidence rate of bronchopulmonary dysplasia and necrotizing enterocolitis was obviously increased.3.From the single factor logistic regression analysis,it showed that the gestational age and birth weight were protective factors of LOS.The older the gestational age,the heavier the body weight,the lower the incidence rate of LOS(P=0.001,OR=0.12;P=0.04,OR= 0.065).Absolutely parenteral nutrition time was a risk factor for LOS(P=0.03,OR=1.332).The longer the absolutely parenteral nutrition time was,the higher the incidence rate of LOS was.4.From the multi-factor logistic regression analysis,it showed that the absolutely parenteral nutrition time and birth weight were high risk factors for LOS(P=0.04,P=0.047).5.47 cases of children patients diagnosed with LOS were cultured with 49 pathogens,and 2 children patients suffered from sepsis twice.Among them,28 cases(57.14%)were Gram-positive bacteria,including 11 cases of Staphylococcus epidermidis,6 cases of Enterococcus faecalis,5 cases of Staphylococcus haemolyticus,3 cases of Staphylococcus aureus,and 3 cases of Streptococcus agalactiae,respectively.The drug sensitivity showed that they were all sensitive to vancomycin.And there were 6 cases of methicillin resistant coagulase-negative staphylococci(MRCNS),including 4 cases of Staphylococcus epidermidis and 2 cases of Staphylococcus haemolyticus,respectively.There was 1 case of methicillin-resistant staphylococcus aureus(MRSA).There were 18 cases(36.73%)of Gram-negative bacteria,including 10 cases of Klebsiella pneumoniae,5 cases of Escherichia coli,2 cases of Acinetobacter baumannii,and 1 case of Pseudomonas aeruginosa,respectively.The drug sensitivity showed they were all sensitive to meropenem.And there were 3 cases of extended-spectrum β-lactamases(ESBL),including 2 cases of Klebsiella pneumoniae and 1 case of Escherichia coli.There were 3 cases(6.13%)of fungi,which were Candida albicans and were all sensitive to fluconazole.Conclusions1.Very low birth weight infants had a higher risk of late-onset sepsis and a high mortality rate,prolonged hospital stay.2.The smaller the gestational age and the lower the birth weight,the higher the incidence of LOS;absolutely parenteral nutrition time and birth weight are independent risk factors for LOS in very low birth weight infants.3.After the occurrence of LOS,the incidence rate of bronchopulmonary dysplasia,bacterial meningitis and necrotizing enterocolitis was obviously increased.4.The pathogens of late-onset sepsis were mainly Staphylococcus epidermidis and Klebsiella pneumoniae.Gram-positive cocci were all sensitive to vancomycin;and Gram-negative bacteria were all sensitive to meropenem.MRCNS,ESBL and MRSA were common multiple resistant bacteria.