A Population-Based Prospective Study On Early-onset Neonatal Infection

Objective:To study the clinical value and effectiveness of early-onset neonatal infection guideline by prospective study and epidemiological method.Methods:Prospective study was designed to observe cases of 821 which were suspicious of early-onset neonatal infection from January 2008 to December 2010 fellowing. the early-onset neonatal infection guideline And cases of 239 which were suspicious of and diagnosed early-onset neonatal sepsis were retrospective surveyed from January 2006 to December 2006. Two set of clinical data were analysed on high risk factor, cilinical manifestation treatment and outcome. Comparative research was performed focus on the difference in the morbidity, mortality, critical illness rate and the duration of antibiotic using before and after application of the early-onset neonatal infection guideline. Pathogenic microorganisms distrubition and drug sensitivity of EONI were summaries too.. We analyzed high risk factors of early-onset neonatal infection with multiple factor logistic regression analysis, Enumeration date such as clinical manifestation were analyzed byχ2 test. The comparing of morbidity, mortality, critical illness rate was analyzed byχ2 test. Antibiotics treatment course coincided with abnormal distribution was analyzed by rank sum test.Result:1. Gestational age<35weeks(OR:2.653), chorioamnionitis (OR:2.205),without adequate antenatal care(OR:1.894), prolonged premature rupture of membranes>18 hours(OR:1.731) were strongly associated with EONI depending on our date. Vaginal delivery was protective factor to EONI(OR:0.402).2. The incidence of EONI were from 17.38 to 24.09 per 1000 live births after we have been using the early-onset neonatal infection guideline from 2008 to 2010, while the incidence of EONI of 13.19 per 1000 live births, the morbidities in two eras were significant difference(χ2=19.448,P<0.0001).3. The rate of serious EONI were ranged from 5.88% to 6.90% from 2008 to 2010, while the rate was 32.26% in 2006, there were significant difference(χ2=19.448,P<0.0001) in two era.4. We report the case fatality rates for EONI in the range 1.28% to 3.92% from 2008 to 2010, while it was 16.13% in 2006, there were significant difference(χ2=19.881,P<0.0001) in two eras.5. The antibiotic therapy duration of neonates who were undefined EONI finally ranged from 3.64±1.96 days to 3.98±2.04 days from 2008 to 2010, while it was 6.00±2.31 days in 2006, there were significant difference(Z=199.538,P<0.001) in two eras. But to those neonates who were diagnosed EONI finally, the antibiotic therapy durations were not significant difference in two eras.6. It was 32 which the major pathogens of EONI in our hospital were gram-positive organisms(86.49%), including 24 of coagulase negative straphylococcus. Which were 12 in 24 were methicillin resistant coagulase negative straphylococcus, but were sensitive to vancomycin,quinolone and aminoglycoside.Conclusion:Application of the EONI guideline may improve the diagnostic accuracy and reduce misdiagnosis and missed diagnosis of early-onset neonatal infection. And the mortality and the critical illness rate of EONI can be decreased after using the EONI guideline. Also, the guideline is helpful for rational using antibiotics for neonates who are suspicious of EONI. Which the major pathogens of EONI in our hospital were gram-positive organism.