Clinical Manifestations And Treatment Of Early-onset Neonatal Sepsis

Aim: To realize the difference between China and France in the clinicalmanifestations, diagnosis and treatment of early-onset neonatalsepsis(EONS) and to provide biasis to improve the level of our hospital indiagnosing and treating this disease.Materials and methods:146cases of EONS patients areretrospectively analyzed. All cases are collected from Children’s Hospitalof Chongqing Medical University in China and Hautepierre Hospital ofStrasbourg University in France. Bacterial spectrum, clinical manifestations,use of antibacterial drugs, occurrence of recording and screening ofperinatal risk factors are compared between the two hospitals.Results: The most common pathogenic bacteria in our hospital areCoagulase-negative staphylococcus(69.2%), Escherichia coli (15.4%),Klebsiella pneumoniae (7.7%) and Habitat of Micrococcus (7.7%) whilein Hautepierre Hospital, Group B streptococcus (33.3%), Escherichia coli(33.3%), Coagulase-negative staphylococcus (16.7%) and Moraxella(16.7%). The most common pathogenic bacteria in gastric liquid andperipheral swabs of Hutepierre Hospital are Escherichia coli(33.3%), Group B streptococcus (21.2%), Coagulase-negative staphylococcus(18.2%)etc. Total days of antibacterial use(11.4±7.2d), mean sorts of antibacterialdrugs for single patient (3.1±0.9) and proportion of patients who hadantibacterial drug changes (70.2%) are greater than Hautepierre Hospital(6.2±2.5d，2.2±0.8，9.9%). Both hospitals are inclined to combine2antibacterial drugs for the first dose (second-generation cephalosporins+semi-synthetic penicillin in our hospital vs. amoxicillin+amikacin inhautepierre hospital). The common second and third line antibacterial drugsin our hospital are carbapenems and vancomycin vs. third-generationcephalosporins and vancomycin in Hautepierre Hospital). The rates ofoccurrence of recording and screening perinatal risk factors(chorioamnionitis, maternal fever, prolonged rupture of membranes,screening results of vaginal swabs or unitary infection, amniotic fluidcontamination, prenatal antibacterial prophylaxis, anamnesis of EONS) inour hospital is all lower than Hautepierre Hospital. There is statisticaldifference in positive rate of amniotic fluid contamination, prolongedrupture of membranes and anamnesis of EONS between the two hospitals.For newborns hospitalized for immediate abnormalities after birth, the mostcommon symptom is respiratory distress (96.5%vs.88.2%). For thoseadmitted after a period of time after birth, the proportion of abnormalities isdifferent: in our hospital, the most common reasons are respiratory distress(44.4%) and lethargy (22.2%) while in Hautepierre Hospital are rise of C reactive proteins (78.2%) and fever (5.5%). The false negative rate of Creactive proteins in diagnosing EONS is not statistically different betweenthe two hospitals.Conclusion: Emphasis on screening and recording perinatal riskfactors, as well as promoting co-operation with obstetric department canimprove the accuracy of early diagnosis of EONS. Positive attitude tobacteria culture and drug susceptibility test may reduce unnecessarychanges and the total time of antibiotic use. China still needs large sample,multi-center studies to determine the necessity to distinguish early-onsetand late-onset neonatal sepsis and specific dividing point. We also need toperfect the guidelines of empirical antibacterial treatment for EONS. Morecomparative studies are claimed between China and European countries indiagnosing and treating EONS.