Epidemiology Investigation On Capillary Leakage Syndrome Occurring In Critically Ill Newborns

BackgroundCapillary leak syndrome(capillary leakage syndrome CLS)is one of the common critical cases in neonatal ward,with complex clinical manifestations and blurred in stages.There were no clear criteria for diagnosis and treatment.Severe cases can lead to heart,brain,lung,kidney or other multiple organ dysfunction syndrome(MODS).With the improvement of quality of medical care,many patients with severe CLS had further opportunity to cure.However,with the lack of internationally recognized standards for early diagnosis and treatment,preventive treatment is limited.Especially,the methods of helping newborns with CLS have been lack of large-scale clinical research.A variety of diagnostic and therapeutic measures is still controversial.The treatment of CLS is a comprehensive engineering.With the growing number of the treatment of critically ill children,as well as the emergence of new therapeutic concepts and advanced circulation monitoring method of constantly emerging,It has become possible to cure critically ill newborns with CLS.ObjectiveThe treatment of CLS is a integrated management scheme.There are so many factors affecting the therapeutic effect.Therefore,it is of great significance to explore the effective methods for early prediction and treatment in the development of CLS,to reduce the complications,shorten the length of hospital days,reduce the cost,decrease the mortality and improve the prognosis.At present,the domestic and foreign literatures are mainly aimed at research of CLS in infant and young child and adults.There has been no epidemiological reports about CLS in critically ill neonates.We investigated the incidence of CLS and its influencing factors,treatment and prognosis in 3 hospitals in Guangzhou from January 1st,2011 to December 31,2015,to obtain epidemiological data in critically ill neonates with CLS,which can provide basis for clinical diagnosis and management of CLS.Methods1.Objects were critically ill newborns with CLS in Department of Neonatology of 3 tertiary hospitals(Nanfang Hospital,Guangzhou Maternal and Child Hospital,the Third Affiliated Hospital of Guangzhou Medical University)in Guangzhou from January 1 st,2011 to December 31,2015.2 Diagnostic criteria:The diagnostic criteria of critically ill neonates with reference to Chinese Medical Association Critical Score for neonates(a draft),score<90 belong to critically ill cases.The inclusion criteria of CLS:?primary disease can not explain why the blood pressure and central venous pressure decreased;?systemic edema,associated with pleural or peritoneal effusion or pericardial effusion;?the oxygenation index is less than 300 mmhg;?the chest radiograph prompted interstitial exudation;?the serum albumin was significantly lower(<25g/L),and HCT did not significantly decrease.Exclusion criteria:Exclusion criteria:cardiogenic,nephrogenic,hepatic edema and hereditary metabolic edema.3.Statistical analysis:All data was analyzed with SPSS 19.0 statistical softwar.Measurement data were expressed by x±s and the median([M(P25-P75)]).Count data pressed by ?2 test.Multivariate logistic regression analysis was used to an alyze the risk factors.P<0.05 was statistically significant.Results1.Morbidity and mortality:the total number of critically ill newborns in Department of Neonatology of 3 tertiary hospitals in Guangzhou from January 1st,2011 to December 31,2015 was 3029 cases,49 cases with CLS,of which 15 cases of death.The morbidity was 1.62%,95%confidence interval(CI)was 1.17%?2.07%.The mortality was 30.6%,95%CI was 17.71%?43.51%.2.The basic items of CLS patients:There were 49 cases with CLS in the all critically ill neonates,including 36 males(73.5%)and 13 females(26.5%).There was no statistically significant difference between male and female(1.88%vs 1.16%,P =(48.9%).The gestational age was(26?41+4)week,the average gestational age was(32.8±4.5)weeks.The birthweight(750?3740 g),average(1890 ± 840)g.There are 24 cases of cesarean section(48.9%),12 cases of multiple pregnancy(24.5%),34 cases of premature and low birth weight infants(69.4%),2 cases of IVF babie(4.1%).20 mothers with risk factors(40.8%).There are 12 cases of intrauterine infection(24.5%),17 cases with birth asphyxia(34.7%),19 cases with congenital anomalies(38.8%,including 14 cases of heart disease,2 cases with gastrointestinal malformation,1 cases with congenital hypothyroidism,1 cases with congenital diaphragmatic hernia,1 cases with G6PD deficiency).8 cases(16.3%)were positive for blood culture,of which 4 cases were Staphylococcus epidermidis,2 cases Stenotrophomonas maltophilia,1 case Acinetobacter spp,1 case Enterococcus faecalis,1 case Pseudomonas aeruginosa,Multiple blood cultures detected Staphylococcus aureus,Stenotrophomonas maltophilia,Acinetobacter baumannii,Enterococcus faecalis in one patient.11 cases were diagnosed as sepsis.Multivariate logistic regression analysis of CLS showed that the risk factors of CLS were maternal risk,shock,ARDS,congenital heart disease etc.3.In the treatment,45 patients(91.8%)received ventilator-assisted ventilation with a median duration of 12(4.5-25.5)d;44 patients(89.7%)received antibiotics with a median duration of 14(7.5-28.5)d;24 cases of glucocorticoid(51.0%,mainly using low-dose dexamethasone or hydrocortisone),the median duration of 3(3.0-9.5)d,including the use 3d patients accounted for 44%,?3d accounted for 60%,? 15d accounted for 96%.30 cases(61.2%)of blood products,29 cases of albumin(59.2%),the artificial colloid 20 cases(40.8%),15 cases of pulmonary surfactant(30.6%),9 cases with surgical treatment(18.3%),in addition to intravenous nutritional support,diuretics,sedatives,exchange transfusion therapy and so on.4.Progression and outcome:among the 49 children with CLS,34 cases were improved(69.4%),15 cases were dead(30.6%).The median time for edema occurred on the second day after admissionon 2-3),of there were 4 cases(8.2%)onset within 24 hours of admission,29 cases(59.2%)within 48 hours,41 cases(83.7%)within 72 hours.The median duration of edema was 7(3-10)d.The median length of hospital stay was 21(8.5-51)d.Among them the median length of stay of improved discharge children was 21(16.7-59.5)d,the median length of stay in dead cases was 4(2-17)d,P<0.001.Multivariate logistic regression analysis showed that the main factor affecting the outcome of CLS was MODS.Conclusion1.CLS is one of the critically illness in neonatal wards.Although the incidence rate is not as high as imagined,the mortality rate is high and the prognosis is poor.There is desperately needed to improve survival rate and the prognosis of neonates with CLS through early prediction and early intervention.2.The risk factors of CLS in newborns with critical illness were maternal risk,shock,ARDS,congenital heart disease etc.3.The edema of CLS patients occurred within 72 hours of admission and lasting for about 1 weeks;4.Infants with CLS had a longer hospitalization time.Most of the death occurred in the early admission.The main factor affecting the outcome of CLS was MODS.