| ObjectiveTo investigate the early treatment measures and key factors affecting the prognosis of neonatal septic shock (NSS), so as to improve the prognosis and increase the recovery rate.Methods82 NSS children were enrolled retrospectively in Children’s Hospital, Chongqing Medical University from September 2009 to February 2013. The early treatment measures and factors affecting the prognosis were analyzed.Results(1)We identified 82 cases of NSS. The ratio of NSS between boys and girls was 1.93:1. Top three of the diseases which cause NSS were digestive tract perforation(26.8%)、necrotizing enterocolitis (24.4%)and septicemia (23.2%).In terms of outcome,53 (64.6%) patients improved,29 (35.4%) patients failed. The onset time of septic shock occurrence between two groups of patients:days of age≤7were 25 (56.8%) vs 19 (43.2%), days of age>7were 28 (73.7%) vs 10 (26.3%) difference between two groups is not statistically significant.41(50%) patients had mild shock,33(80.5%) improved,8(19.5%) failed.31(37.8%) patients had moderate shock,18(58.1%) improved,13(41.9%) failed and 10(12.2%) patients had severe shock,2(20.0%) improved,8(80.0%) failed. Difference in the degree of septic shock between two groups of patients is statistically significant(P=0.001). Only 6(11.3%) patients had been improved from shock in 1h,28(52.8%) patients in 1-6h and 19(35.9%) patients in over 6h. (2)A11 of the patients had respiratory support, volume infusion and antibiotic application.59(72.0%) patients had inotrope application, 38(64.4%) improved,21(35.6%) failed.47(57.3%) patients starting volume infusion in 1h,40(85.1%) improved,7(14.9%) failed; while 35(42.7%) patients are over 1h,13(37.1%) improved,22(62.9%) failed. Difference between two groups of patients is statistically significant(P<0.001).42(71.2%) patients had 2 peripheral venous accesses in improved group, this number in failed group is only 17(28.8%).The first liquid of volume infusion for 75(91.5%) patients is normal saline. Differences in the kinds and dose of liquid for volume infusion between two groups are not statistically significant. Patients received.volume infusion only once in two groups are 46(78.0%) vs13(22.0%), the time of two groups are (0.65±0.35)h vs(1.03±.55)h, (P=0.036). Patients received twice of volume infusion in two groups are 7(38.9%) vs11(61.1%), the speed of two groups are (35.81±13.03)ml/kg.h vs(18.77±6.26)ml/kg.h, (P=0.002).24(29.3%) patients had antibiotic application before shock occurrence.20(24.4%) patients applicated in 1h from shock occurrence, 17(85.0%) improved vs 3(15.0%) failed.38(46.3%) patients applicated over 1h,22(57.9%) improved vs 16(42.1%) failed. Difference in the time of antibiotic application(in and over 1h) between two groups is statistically significant(P=0.037).29(49.2%) patients starting inotrope application in 1h,23(79.3%) improved vs 6(20.7%) failed; 30(50.8%) patients are over 1h,15(50.0%) improved vs 15(50.0%) failed. Difference in the starting time of inotrope application between two groups of patients is statistically significant(P=0.019). Among 59 patients who had inotrope application, 20(33.9%) patients were applied with dopamine and dobutamine,16(80.0%) improved vs 4(20.0%) failed. The using frequency from high to low is dopamine(100%), dobutamine (84.7%), phentolamine (39.0%), epinephrine (22.0%), milrinone(10.2%), norepinephrine (6.8%). Difference in the dose of inotrope between two groups of patients is not statistically significant.ConclusionsThe improved rate of NSS is reduced along with the shock degree aggravating. To determine the degree of shock as soon as possible can help to judge prognosis and provide the evidence for clinical treatment. It is necessary to establish more than one peripheral venous access in one hour, give aggressive fluid resuscitation and antibiotic application, use the inotrope timely if the patients have liquid refractory shock. Dopamine and dobutamine are the preferred drugs, phentolamine and epinephrine are alternative for NSS. |
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