Analysis Of Clinical Factors In Very Low Birth Weight Infants With Late-onset Sepsis

Objective: To analyze the clinical characteristics, risk factors,distribution and pathogens of bacteria in very low birth weight infants(VLBW) with late-onset sepsis(LOS), provide guidance for early identifications and treatment of LOS, and improve the level of clinical treatment..Methods:In this study, a total of 102 cases of VLBW with LOS were collected from January 2013 to December 2014 in the NICU of Suzhou Municipal Hospital and in the meantime 102 cases of non-infected VLBW as the control group. There were 19 risk factors,such as gender, gestational age, birth weight, mode of delivery, Apgar score, amniotic fluid nature,,the time of premature rupture of membranes, the antibiotic usage of mother, prenatal maternal blood infection, prenatal hormone use, fetal distress, gestational hypertension, Peripherally inserted central venous catheters( PICC),mechanical ventilation, umbilical vein catheter, breastfeeding, Special Care Nursery(SCN) care,vaginal secretion culture, the usage of antibiotics especially the third generation cephalosporins in children. These factors were analyzed by univariate and multivariate Logistic regression analysis in SPSS20.0. At the same time, the distribution of pathogenic in 102 cases of LOS was analyzed staticstically.Results:1. The incidence and prognosis of very low birth weight infants with late-onset sepsis: 332 cases of VLBW were treated from January 2013 to December 2014 in Suzhou Municipal Hospital.The prevalence of LOS was 30.72%,including 77 cases(75%) of LOS confirmed by blood culture, 25 cases(25%) of LOS diagnosised by clinical. There were 15 cases of death in LOS, the mortality rate was 14.71%.2.Univariate analysis showed that: the smaller the gestational age, The higher risk of LOS, P = 0.032; and the gestational hypertension, breastfeeding, SCN care and the usage of antibiotics especially the third generation cephalosporins in children are protective factors for LOS in VLBW, Prespectively were 0.023,0.031, <0.001 and 0.024.3. Logistic regression analysis revealed three independent factors associated with LOS,respectively were gestational hypertension(OR 0.437,95% CI 0.214-0.891, P = 0.023), SCN care(OR 0.149,95% CI 0.066-0.334, P <0.001) and the usage of antibiotics especially the third generation cephalosporins in children(OR 0.492,95% CI 0.267-0.907, P = 0.023).4. The main pathogens in VLBW with LOS were Gram-positive cocci, accounted for 59.76% of the total, and coagulase-positive staphylococci accounted for only 6.10%, while the rest were coagulase-negative staphylococci. At the same time, 35.37% of the total were Gram-negative bacteria,4.88% were fungi.Conclusions : 1.LOS is still one of the critically illniss in VLBW, with high prevalence and high mortality.2. Pregnancy hypertension, SCN care and the usage of antibiotics especially the third generation cephalosporins in children are the independent protective factors of LOS occured in VLBW.3.Gram-positive bacteria are the main pathogens of LOS, especially coagulase-negative staphylococci.