Significance Of Neonatal Early-Onset And Late-Onset Septicemia: Case Analysis

Objects To observe the pathogen, onset day , relative markers and susceptibility test result of neonatal early-onset and late-onset septicemia in order to probe the value of neonatal septicemia different into early-onset and late-onset.Methods A retrospective review of 423 hospitalized neonates with blood culture positive in our hospital from 2000 to 2006 was analyzed. All statistical analyses were performed with the use of SPSS 15.0.Results The 423 cases accounted for 2.2%(423/19135) of the hospitalized neonates at the same periods . Of 121 strains of pathogen from antepartum and intrapartum bacteria, Escherichia.coli was prominent [36.4% (44/121)], while postpartum bacteria, the most common bacteria was coagulase-negative staphyccoci(CoNS) [93.4%(282/302)]. Antepartum and intrapartum infective bacteria had prominent relation with antepartum, preterm labor contrast to postpartum infective bacteria (p<0.05).≤72h and >72h, antepartum and intrapartum infective bacteria occupied 37% to 25.8%.≤5d and >5d, antepartum and intrapartum infective bacteria 46.9% to 17.2%.≤7d and >7d, antepartum and intrapartum infective bacteria 45.6% to 11.1%, all had statistically difference(p<0.05). For the neonates less than 48h, the first four common pathogen was Staphylococcus epidermidis(25.5%), Staphylococcus hemolyticus(17.6%),Escherichiacoli(11.8%),Klebsiellapneumoniae(3.9%).For the neonates respevtively less than 72h,5d,7d, the first four prior pathogen was Staphylococcus epidermidis, Escherichia coli, Staphylococcus hemolyticus, Staphylococcus hemolyticus, and the difference in percentage was no satisfactory. The infants older than 7d, the four dominant pathogen was Staphylococcus epidermidis(29.3%), Staphylococcushemolyticus(25%),Staphylococcusaureus(4.8%),Staphylococcus huminis(3.8%).Onset≤5d, 7d after birth, there was prominent relation with premature rupture of the membranes, antepartum fever, but there was no difference between the two periods. Onset during 7th day of life , the investigation markers such as WBC, PLT, CRP were more sensitive, and the mortality was higher, and prominently relative to delivery method(p<0.05); Antepartum and intrapartum infective bacteria had prominent relation with abnormal birth weight, abnormal WBC, decrease PLT, high CRP(p<0.05). Drug susceptibility test result: respectively less than≤ 48h, 72h, 7d, the test result had no prominent difference. Respectively less than≤7d, Piperacillin (100%), Cefaroxime(81.8%), Ceftazidime(76.9%), Rifampinthe(70.6%) had high susceptibility. >7d, Rifampinthe (86.8%), Ciproflozacin(69%), Piperacillin(66.7%), Norfloxacin(64.5%) had high susceptibility; There was no pathogen resistance to Vancomycin.Conclusions 7th day after birth was threshold to different the early-onset and late-onset septicemia. Early-onset septicemia had relation with perinatal risk factors such as premature rupture of the membranes, antepartum fever. The differentiate of neonatal early-onset and late-onset septicemia had some value for choose the antibiotics.