The Clinical Characteristics Of Early-onset Neonatal Sepsis With Respiratory Distress As The First Manifestation

Objective: The aim to this study is to study the clinical characteristics of early-onset neonatal sepsis with respiratory distress as the first manifestation for early diagnosis of these kind of newborns.Methods: Clinical data of 640 patients diagnosed as early-onset neonatal sepsis in children’s hospital of Chongqing medical university from Jan 2010 to Oct 2015 were retrospectively analyzed. These patients were divided into 2 groups: having respiratory distress as the first manifestation group(group A) and having no respiratory distress as the first manifestation group(group B). The differences between two groups were analyzed including the following aspects: general situation, perinatal factors, complications, inflammatory markers, blood culture pathogens of sepsis and their antibiotic susceptibility and so on.Result: There were 243 patients in group A, and 397 patients in group B. Among group A, there were 151 preterm infants(62.1%), 131 low birth weight infants(53.9%), The incidence of premature rupture of membranes(≧18 hours) was 11.1%, They were all found to be higher than group B(25.2%, 21.9%, 5.0%)(P<0.05). The rate of cesarean delivery of group A and group B were 61.7% and 40.8%, rate of twins were 17.7% and 3.8%, The differences were statistically significant(P<0.05).The rate of the mothers developed gestational diabetes mellitus(12.3%), gestational hypertension(8.6%) were higher in group A than group B(5.5%, 3.5%)(P<0.05). There were 42.4% patients dead or abandoning treatment in group A,while 13.4% in group B(P<0.05).The rate of the complications of early-onset neonatal sepsis in group A such as pulmonary hemorrhage, pneumothorax or pneumomediastinum, Bronchopulmonary dysplasia, septic shock, intracranial hemorrhage were 19.8%, 7.4%, 3.7%, 4.1%, 29.2% respectively. They all showed a lower rate in group B(0.3%,0%,0.5%,0.5%,17.4%)(P<0.05). There were 16.0% patients developed meningitis in group A, and 14.3% in group B, significant difference had not been found in two groups(P>0.05).In group A and B, the rate of white blood cell<5×109/L were 16.5% VS 9.1% on the day of admission, 21.0% VS 11.1% on the day of diagnosising sepsis(P<0.05). The rate of white blood cell>20×109/L or >25×109/L in the group B were 33.2%( on the day of admission) and 35.3%(on the day of diagnosising sepsis), while group A were 18.1%(on the day of admission) and 23.0%(on the day of diagnosising sepsis)(P<0.05). Both Platelets and procalcitonin were proved to have no statistically significant difference in two groups(P>0.05).Blood culture of 74 infants were positive(11.6%), The top 3 blood culture pathogens of early-onset neonatal sepsis were epidermis staphylococcus(17, 22.4%), E. coli bacterium(13, 17.1%), klebsiella pneumoniae pneumonia subspecies(10, 13.2%). The most common pathogen in the group A is coagulase negative staphylococcus(5, 35.7%). The antibiotics susceptibility to the bacterial showed: the susceptibility of Vancomycin, Carbapenems, three or four generation Cephalosporins and Amoxicillin were as high as 100% to gram-positive cocci, while the susceptibility of most Penicillins, such as Penicillin, Ampicillin, Amoxicillin/Acid were only 8%-21%, and Cefoxitin showed all resistance. The susceptibility of Carbapenems was highest to the gram-negative bacillus(93.1%), the clinical commonly used antibiotics such as Piperacillin/Tazobactam and Ceftazidime, the susceptibility were varied from 82% to 87%, while the susceptibility of Ampicillin, Piperacillin and Cefazolin were only 10% to30%.Threr were 123 patients performed neonatal respiratory distress syndrome like chest radiographs in group A(52.9%). The improvement rate of the chest-ray manifestations after using pulmonary surfactant was 56.5%. The patients whoes first time chest radiographs performed like neonatal respiratory distress syndrome, had characteristic appearances of inflammatory markers: All the inflammation index positive rate were not high within 12 hours(abnormal rate < 31%), in 12 hours to 24 hours, the abnormal rate of white blood cells and C- reactive protein were 43.3% and 53.3% respectively, The positive rate of platelets within 12 hours was lower than 25%, but up to 30% in 12 hours to 72 hours, The positive rate of inmmature/total neutrophils ratio was always low(< 19%).Conclusion: Early-onset neonatal sepsis with respiratory distress as the first manifestation has the fallowing characteristics:1.Small gestational age, low birth weight, premature rupture of membranes(18 hours or higher) is more common, and the mortality is high. 2. Under the high risk factors such as infection, ischemia, mechanical ventilation, early onset neonatal sepsis is more like to complicated with lung hemorrhage, septic shock, pneumothorax or pneumomediastinum, intracranial hemorrhage, and bronchopulmonary dysplasia, etc.3. The white blood cell < 5×109/L is more common in the patients with respiratory distress as the first manifestation; Blood routine most like to be normal within 12 hours; White blood cell and C-reactive protein are more like to be abnormal in 48 hours to 72 hours; Inmmature/total neutrophils ratio may has no significance in diagnosis early onset neonatal sepsis. 4. There are more than half showed a neonatal respiratory distress syndrome like chest radiograph in the patients with respiratory distress as the first manifestation. To this part of patients, the improvement rate is unsatisfactory after using pulmonary surfactant.5. The most common pathogens of were coagulase negative staphylococcus aureus and E.coli, Vancomycin and Linezolid are sensitive to the former, and Carbapenems, Piperacillin/Tazobactam and three or four generation Cephalosporin are sensitive to the latter.