| Objective:Birth cohort based research,To analyze the baseline situation of early onset sepsis(EOS)in mid to late preterm infants in a single center,To explore the relevant risk factors for early onset sepsis in mid to late preterm infants,High throughput sequencing(16S r RNA)was used to detect the distribution of early intestinal flora in mid to late preterm infants with early onset sepsis,To evaluate the significance of early intestinal microflora types,quantities,and distribution characteristics in the diagnosis of early onset sepsis in mid to late preterm infants,To identify high-risk infants early on,Reduce unnecessary antibiotic use,Provide clinical basis for predicting the occurrence and further development of EOS.Methods:1.A prospective study was conducted to collect clinical data from preterm infants with birth gestational age of 32 to 37 W and cesarean delivery who were admitted to the neonatal intensive care unit of Linyi People’s Hospital from September 1,2021 to September 1,2022.According to the EOS diagnostic criteria,they were divided into EOS group and non EOS group,and the occurrence status of EOS was analyzed.Screening for risk factors related to the occurrence of EOS through single factor and multiple factor analysis.2.Randomly selected cases from September 1,2021 to December 31,2021,Premature infants whose mothers have diabetes are excluded,Collect the first feces of premature infants within 1 hour after birth,The composition of intestinal flora in fetal feces was analyzed using high throughput sequencing(16S r RNA)analysis techniques.Further,according to the EOS diagnostic criteria,they were divided into sample EOS group and sample non EOS group,Explore the characteristics of early intestinal flora in mid to late preterm infants with EOS.Results:1.Inclusion population and EOS occurrence status:A total of 338 premature infants were enrolled from September 1,2021 to September 1,2022,Among them,197 were male(58.28%)and 141 were female(41.72%).There were 85 children with EOS(25.15%)and 253 children without EOS(74.85%).2.Risk factors affecting the occurrence of EOS:Univariate analysis showed that gestational age is a risk factor for the occurrence of EOS in mid to late preterm infants.The smaller the gestational age,the higher the risk of EOS.Multifactor logistic analysis showed that,In addition to the time of membrane rupture ≥ 18 h,diabetes in pregnant women,umbilical cord around the neck,and placental abnormalities are independent risk factors for the occurrence of EOS in late preterm infants.1-minute Apgar score: As the1-minute Apgar score increases,the risk of EOS decreases.3.Characteristics of intestinal flora: There are differences in the type and quantity of OTUs between the EOS group and the non EOS group,and the type and quantity of OTUs between the non EOS group and the non EOS group are significantly better than those of the EOS group.At the phylum level,the sample EOS group and the sample non EOS group are mainly composed of four phyla,namely Proteobacteria,Thickwalled Bacillus,Actinomycetes,and Bacteroides,The relative abundance of pachyderma in the EOS group was higher than that in the non EOS group,while the relative abundance of actinomycetes was lower than that in the non EOS group.At the class level,the sample EOS group and the sample non EOS group are mainly composed of five classes of bacteria,which are γ-Proteobacteria,Clostridium α-Proteobacteria,Bacteroides,Bacillus,Sample EOS group γ-The relative abundance of Proteobacteria,Bacteroides,and Bacilli was higher than that of non EOS group,Clostridium α-The relative abundance of Proteobacteria was lower than that of non EOS group.At the order level,both the sample EOS group and the sample non EOS group are mainly composed of 5 bacterial orders,which are not clearly identified γ-Proteobacteria,Pseudomonas,Vibrio,Enterobacteriaceae,Corynebacterium,Unspecified γ-The relative abundance of Proteobacteria and Vibrio was higher than that of non EOS group,while the relative abundance of Pseudomonas,Enterobacteria,and Corynebacterium was lower than that of non EOS group.At the family level,both the sample EOS group and the sample non EOS group are mainly composed of four bacterial families,namely,Berkshires,Moraceae,Pseudomonas,and Vibrio,The relative abundance of Burkholderia,Pseudomonas,and Vibrionaceae in the EOS group was higher than that in the non EOS group,while the relative abundance of Moraceae was lower than that in the non EOS group.At the genus level,the sample EOS group and the sample non EOS group are mainly composed of four genera,namely Ralstonia,Acinetobacter,Pseudomonas,and Vibrio,The relative abundance of Ralstonia,Pseudomonas,and Vibrio in the EOS group was higher than that in the non EOS group,while the relative abundance of Acinetobacter was lower than that in the non EOS group.Conclusion:1.Single center result display:Single center results show that the incidence of EOS is still high in premature infants with gestational age of 32～37W and cesarean section,and there is still a need for early anti infective treatment for mid to late stage premature infants.2.For premature infants with gestational age of 32-37 W and cesarean section,gestational age,maternal diabetes,umbilical cord around the neck,placental abnormalities,and membrane rupture time ≥ 18 h are risk factors for EOS.The 1-minute Apgar score is a protective factor for EOS in mid to late preterm infants.3.The early intestinal microflora analysis results of premature infants in the EOS group and non EOS group showed that:There are certain differences in the intestinal flora between the EOS group and the non EOS group of mid and late preterm infants,The species richness and community diversity of the EOS group were lower than those of the non EOS group.The analysis of intestinal microflora may have implications for the occurrence of EOS in mid to late preterm infants,Early intestinal flora may be used as a screening method for early onset sepsis in mid to late preterm infants. |
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