Retrospective Analysis Of Neonatal Sepsis From 2019 To 2022

ObjectiveFrom November 2019 to November 2022,the clinical data of neonates diagnosed with neonatal sepsis in the Department of Neonatology,Foshan Maternal and Child Health Care Hospital were retrospectively investigated.The high-risk factors of neonatal sepsis,clinical characteristics of early-onset and late-onset sepsis,early identification of laboratory tests and distribution of pathogenic bacteria in blood culture were analyzed.To provide a theoretical basis for early identification and intervention of neonatal sepsis.Methods1.The clinical data of 335 cases of neonatal sepsis in the Department of Neonatology,Foshan Maternal and Child Health Hospital from November 2019 to November 2022 were collected.EXCEL software was used to establish a database for retrospective analysis.2.The clinical data were compared and analyzed according to the results of blood culture,early-onset and late-onset,preterm and full-term,Gram-positive bacteria(G+bacteria)and Gram-negative bacteria(G-bacteria).The application and diagnostic value of inflammatory indicators in neonatal sepsis,the distribution and drug resistance of pathogens in neonatal sepsis in recent 3 years were analyzed.The statistically significant variables were included in the binary Logistic regression analysis for multivariate analysis to explore the high risk factors of neonatal sepsis.Results1.Preterm birth,very low birth weight,Apgar score ≤7,intravenous nutrition,maternal group B β-hemolytic streptococcal infection,gestational hypertension and other factors are related to neonatal sepsis.2.There were 169 cases of early-onset sepsis,including 127 full-term infants.The main clinical manifestations were jaundice(71.65%),fever(18.11%)and vomiting(10.24%).Forty-two premature infants had the main clinical manifestations of shortness of breath(64.29%),abdominal distension(28.57%),and poor response(28.57%).There were 166 cases of late-onset sepsis,including 100 full-term infants.The main clinical manifestations were fever(81%),irritability(18%),and poor feeding(17%).There were 66 premature infants,and the clinical manifestations included abdominal distension(57.58%),poor response(53.03%),bleeding symptoms(46.97%),cyanosis(33.33%),and apnea(21.21%).3.The optimal cut-off value of procalcitonin was 2.5ug/L(AUC 0.716).The optimal cut-off value of procalcitonin/C-reactive protein was 0.05(AUC 0.714).The optimal cut-off value of procalcitonin/albumin was 0.08(AUC 0.709).The optimal cut-off value of platelet in gram-negative bacterial infection of neonatal sepsis was 106×109/L(AUC 0.668).The optimal cut-off value of prealbumin was 68mg/L(AUC 0.655).4.Coagulase negative staphylococci(14/63,22.22%),Escherichia coli(12/63,19.05%)and Enterococcus faecalis(6/63,9.52%)were the main pathogens of neonatal sepsis.5.The main gram-positive bacteria of neonatal sepsis are Staphylococcus epidermidis,Enterococcus faecalis and Streptococcus agalactiae.The drug resistance analysis showed that Staphylococcus epidermidis had high resistance to penicillin G,oxacillin,ampicillin,amoxicillin-clavulanate,and was 100%sensitive to linezolid,moxifloxacin,tigecycline,nitrofurantoin,quinupristin/dalfopristin,and gentamicin.Gram-negative bacteria were mainly Escherichia coli,Enterobacter cloacae complex,Klebsiella pneumoniae subsp.Escherichia coli was highly resistant to cefepime,ampicillin and ceftazidime,and 100%sensitive to ertapenem,cefotetam,amoxicillinclavulanic acid and meropenem.Conclusion1.Preterm birth,very low birth weight,Apgar score ≤7,intravenous nutrition,maternal group B β-hemolytic streptococcal infection,and gestational hypertension can increase the risk of neonatal sepsis.2.In early-onset sepsis,the clinical manifestations of full-term infants were mainly jaundice,fever and vomiting,and the clinical manifestations of preterm infants were mainly shortness of breath,abdominal distension and poor response.In late-onset sepsis,the clinical manifestations of full-term infants are mainly fever,irritability and poor feeding,and the clinical manifestations of preterm infants are more common,such as abdominal distension,poor response,bleeding symptoms,cyanosis and apnea.3.Procalcitonin combined with procalcitonin/C-reactive protein and procalcitonin/albumin ratio are helpful for early diagnosis of early-onset sepsis.The decrease of platelet and prealbumin can help to predict G-bacterial infection and provide some basis for early treatment.4.Coagulase negative staphylococci,Escherichia coli and Enterococcus faecalis are the main pathogens of neonatal sepsis.5.Staphylococcus epidermidis is the main G+bacteria in neonatal sepsis,and it has a high resistance to penicillins.Escherichia coli was the main type of G-bacteria,which had high resistance to cefepime,ampicillin and ceftazidime.