Clinical Analysis Of Neutropenia In Preterm Infants

Objective:1.Summarize and analyze the clinical data and influencing factors of premature children with neutropenia admitted to our hospital,observe the etiology and clinical characteristics of premature neutropenia,provide basis for their clinical diagnosis and condition evaluation and guide clinical treatment.2.Through retrospective analysis of preterm neutropenia combined with neonatal sepsis incidence and neutrophil count(absolute neutrophil count,ANC)reduce the onset and duration,explore the correlation between preterm neutropenia and neonatal sepsis,provide a theoretical basis for clinical use of antibiotics.Methods:For this study,from January 2018 to January 2023,Preterm infants with reduced ANC were identified as the observation group,According to the gestational age,the observation group was divided into very early premature infants(<32 weeks)and middle and late premature infants(32 weeks);According to the birth weight,it is divided into very low birth weight group(<1500 g)and low birth weight group(<2000 g);According to the time of onset is divided into early hair(<7 days)and late hair(7 days)neutropenia;According to the degree of ANC reduction,they were divided into mild neutropenia(<1.0109/L)and severe neutropenia(<0.5109/L).In a 1:1 ratio,the clinical data,laboratory indicators and outcomes of the two groups were retrospectively analyzed to explore the risk factors of premature neutropenia and the relationship with neonatal sepsis.Results:1.A total of 3,827 preterm infants were admitted during the current study period,of which 100 were neutropenia,accounting for 2.6%of hospitalized preterm infants in the last 5 years.In the 100 observation group,the proportion of male:female was about 1.38:1,the mean gestational age(30.530±2.234)weeks,and the number of extremely premature infants below 32 weeks was higher,accounting for 69%,and the mean birth weight(1.286±0.438)kg,and the birth weight was less than 1.5kg,accounting for 52%.The most common onset time was<2 days(80%),followed by 2 to 7 days(8%),and>7 days;77 mild ANC and 23 severe ANC in the observation group.2.Compared with the observation and control groups,the reduction of ANC in premature infants showed statistical differences in sex,birth weight,mode of delivery,maternal premature rupture of membranes(Premature rupture of fetal membranes,PROM)>18h,neonatal sepsis,duration of antibiotic use,and increase of C reactive protein(C reactive protein,CRP)(P<0.05).However,there was no statistical significance in gestational age,maternal hypertension(hypertensive disorders of pregnancy,HDP),threatened abortion,fetal distress,postnatal asphyxia,invasive and non-invasive ventilator use time,and use time of parenteral nutrition(P>0.05).3.Seminal abortion,CRP index,duration of antibiotics,mode of delivery,birth weight,and gender were not independent risk factors for reduction of ANC(P>0.005);premature rupture of membranes>18h was an independent risk factor for reduction ofANC in preterm infants(P<0.005).4.The severity of ANC reduction was associated with gestational age(R=-0.462,P<0.001);but there was no association with birth weight(P=0.058).5.The area under the curve(area under the curve,AUC)for the diagnosis of ANC reduction was 0.415(0.036～0.0.494)(P=0.038),with a sensitivity of 30.2%and specificity of 44.6%,with little predictive value for ANC reduction in premature infants.6.There was a correlation between the time to onset of neutropenia in preterm infants and neonatal sepsis(R=-0.199,P=0.047),and the incidence of neonatal sepsis was higher in the late-onset neutropenia group than in the early-onset neutropenia group.The severity of ANC reduction was associated with the duration of ANC reduction(R=-0.228,P=0.023<0.005),and the incidence of sepsis in premature infants increased with the duration of ANC reduction.Conclusions:1.Neutropenia in preterm was common in very preterm and very low birth weight;77%were mild neutropenia,severe only a minority;88%occurred within 7 days after birth.2.The severity of neutropenia in preterm infants was associated with gestational age,with younger gestational age;no correlation with birth weight.3.Maternal premature rupture of membranes for>18h,gender,mode of delivery,birth weight,neonatal sepsis,duration of antibiotic use,and elevated CRP are risk factors for neutropenia in preterm infants.Of these,premature rupture of membranes is an independent risk factor.4.Preterm infants with later onset neutropenia have a higher incidence of sepsis than those with earlier onset neutropenia.5.With the duration of ANC reduction,the incidence of sepsis in premature infants increases.