Risk Factors For Intrauterine Infection Of Preterm Infants And Their Prognosis:A Multi-center Clinical Study

Part ?:Risk factors for intrauterine infection of preterm infants ObjectiveTo explore the risk factors for intrauterine infection of preterm infants so as to provide guidance for clinical early prevention.MethodsThe clinical data of preterm infants,who born from January 2015 to June 2017 in 3hospitals and admitted to the neonatal intensive care unit,and the clinical data of their mothers,were retrospectively analyzed.Maternal risk factors associated with intrauterine infection were compared by using chi-squared test and further study by using multivariate logistic regression.ResultsA total of 1223 preterm infants were recruited.The intrauterine infection occurred in 595 of 1223 their mothers during the pregnance.Compared with preterm infants,whose mothers without intrauterine infection during the pregnance,the percent of mother lived in the country,low level of education,unstandardized prenatal examination,aginal examination more than 4 times,prenatal invasive operation,premature rupture of membranes more than or equal to 12 h,oligohydramnios,amniotic fluid pollution,vaginitis and pelvic infection was significantly higher?P < 0.05?.However,maternal age,pregnant frequency,times of delivery,prolonged labour,cervical abnormality,gestational diabetes,intrahepatic cholestasis in pregnancy and the way of delivery had no effect on the percent of intrauterine infection?P > 0.05?.Additionally,the percent of gestational hypertension,placenta previa or placental abruption was significantly lower than without intrauterine infection?P <0.05?.Multivariate logistic regression indicated that mother lived in the country,unstandardized prenatal examination,aginal examination more than 4 times,prenatal invasive operation,vaginitis,pelvic infection,oligohydramnios and premature rupture of membranes more than or equal to 12 h were independent risk factors for intrauterine infection of preterm infants?P<0.05?.ConclusionMother lived in the country,unstandardized prenatal examination,aginal examination more than 4 times,prenatal invasive operation,vaginitis,pelvic infection,oligohydramnios and premature rupture of membranes more than or equal to 12 h were independent risk factors for intrauterine infection of preterm infants.Therefore,pertinent interventions related to these risk factors are needed to avoid intrauterine infection.Part ?: Outcomes of different gestational ages' preterm infants exposed to maternal intrauterine infection ObjectiveTo explore the effect of maternal intrauterine infection for the complication,mortality and morbidity of different gestational ages' preterm infants,so as to provide guidance for clinical early diagnosis and treatment.MethodsPreterm infants,born from January 2015 to June 2017 in 3 hospitals and admitted to the neonatal intensive care unit,were retrospectively analyzed.According to gestational age,preterm infants were divided into four groups,the first group born from28 to 29⁺⁶weeks of gestation,the second born from 30 to 31⁺⁶weeks of gestation,the third born from 32 to 33⁺⁶ weeks of gestation and the fourth born from 34 to 36⁺⁶ weeks of gestation.Then every group were divided into infected group and uninfected group according to mothers with or without intrauterine infection.Complications and mortality of every infected group's preterm infants were analyzed.Complications,mortality and morbidity of different gestational ages' preterm infants were compared between infected group and uninfected group.ResultsA total of 1223 preterm infants were recruited.77 preterm infants,born from 28 to29⁺⁶ weeks of gestation,were in infected group,70 were in uninfected group;128preterm infants,born from 30 to 31⁺⁶ weeks of gestation,were in infected group,125 were in uninfected group;150 preterm infants,born from 32 to 33⁺⁶weeks of gestation,were in infected group,172 were in uninfected group;240 preterm infants,born from34 to 36⁺⁶ weeks of gestation,were in infected group,261 were in uninfected group.The smaller the gestational age of preterm infants who exposed to maternal intrauterine infection,the higher the incidence of many complications and mortality,especially <32 weeks' complications and mortality were significantly increased?P < 0.05?.The incidence of sepsis,pneumonia,necrotizing enterocolitis and cerebral injury were higher in 28 to 29⁺⁶ weeks' infected group compared with uninfected group?P<0.05?.The incidence of sepsis,pneumonia,necrotizing enterocolitis,cerebral injury and mortality were higher in 30 to 31⁺⁶ weeks' infected group compared with uninfected group?P<0.05?.The incidence of sepsis,pneumonia and cerebral injury were higher in32 to 33⁺⁶ weeks' infected group compared with uninfected group?P < 0.05?.The incidence of sepsis,pneumonia and cerebral injury were higher in 34 to 36⁺⁶weeks' infected group compared with uninfected group?P<0.05?.The smaller the gestational age of preterm infants,the higher the mortality,and the mortality was significantly increased in <32 weeks' infected group compared with uninfected group.The smaller the gestational age of preterm infants,the higher the morbidity,and the morbidity was nearly 100% in <32 weeks' preterm infants,the morbidity was significantly increased in >32 weeks' infected group compared uninfected group.ConclusionIntrauterine infection is associated with multiple complications of preterm infants.The smaller the gestational age of preterm infants,the more the complications associated with intrauterine infection,the higher the mortality,and the more harmful to preterm infants' health.It's important to prevent and treat intrauterine infection early for improving the prognosis of preterm infants.Part ?: Effect of mothers with intrauterine infection used ntibiotics on recent prognosis of preterm infants ObjectiveTo explore the effect of mothers with intrauterine infection used antibiotics on recent prognosis of preterm infants,so as to provide guidance for clinical early anti-infective treatment.MethodsPreterm infants,who were exposed to maternal intrauterine infection,and born from January 2015 to June 2017 in 3 hospitals and admitted to the neonatal intensive care unit,were retrospectively analyzed.According to the duration of mothers used antibiotics,preterm infants were divided into four groups,whose mothers used antibiotics only once were research group A,whose mothers used antibiotics 3 days were research group B,whose mothers used antibiotics ?5 days were research group C,whose mothers didn't use antibiotics were control group.Venous blood white blood cell,neutrophil percentage,platelet count,C-reactive protein,procalcitonin,hemoglobin,and recent complications,mortality,length of stay,rate of antibiotics application,duration of antibiotics application were compared between each group.ResultsA total of 595 preterm infants were recruited.140 preterm infants were in research group A,149 were in research group B,138 were in research group C and 168 were in control group.The antibiotics used by mothers of research groups were cephalosporins with or without azithromycin?P>0.05?.There was no statistical difference of mothers' age,and the rate of primiparity,normative prenatal diagnosis,gestational diabetes and cesarean delivery?P>0.05?.There was no statistical difference of gender,gestational age and birth weight of preterm infants?P>0.05?.The white blood cell and neutrophil percentage were lower in research group B and C compared with control group?P<0.05?;the procalcitonin was lower in research group B and C compared with control group and research group A?P<0.05?;the C-reactive protein was lower in research group C compared with control group and research group A?P<0.05?.The white blood cell,neutrophil percentage and blood platelet positive rate were lower in research group B and C compared with control group?P<0.05?;the procalcitonin positive rate was lower in research group B and C compared with control group and research group A?P<0.05?;the C-reactive protein positive rate was lower in research group B compared with control group?P<0.05?;the C-reactive protein positive rate was lower in research group B and C compared with control group and research group A?P < 0.05?.The incidence of sepsis,pneumonia and mortality were lower in research group B and C compared with control group?P < 0.05?.The length of stay was shorter in research group B and C compared with control group?P < 0.05?.The duration of antibiotics application was shorter in research group B and C compared with control group and research group A?P<0.05?.ConclusionsMothers with intrauterine infection used antibiotics treatment before delivery,could debcrease preterm infants' some venous blood infectious indicators,mortality,and the incidence of sepsis and pneumonia,shorten the duration of antibiotics application and the length of stay.It's important to identify intrauterine infection early and begin appropriate antibiotics treatment for improving the prognosis of preterm infants.