Risk factors and clinical characteristics of late-onset septicemia in neonates_West China Medical Journal

Authors：

 ZHANG Baohui ¹ , WANG Lili ² , QIAN Qingyan ¹ , ZHOU Chunrong ¹

1. Department of Pediatrics, Chaohu Hospital of Anhui Medical University, Hefei, Anhui 238000, P. R. China;
2. Department of Pediatrics, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230022, P. R. China;

Corresponding?author：

ZHANG Baohui, Email: zbh623@163.com

Keywords：

Late-onset; neonatal septicemia; risk factors; clinical characteristics

DOI：

10.7507/1002-0179.202006256

Video：

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Objective To explore the risk factors, clinical characteristics and pathogenic bacteria of late-onset septicemia (LOS) in neonates, so as to guide clinical diagnosis and treatment. Methods Collect LOS in neonates admitted to the Department of Pediatrics, Chaohu Hospital of Anhui Medical University between January 2015 and February 2020, and set them as the observation group. The neonates born at the same time and hospitalized without septicemia were selected as the control group. The general situation and risk factors of the two groups of neonates were analyzed, and the clinical manifestations, complications and pathogenic bacteria of LOS in neonates were analyzed. Results 182 neonates were enrolled, 91 in each group. There were significant differences between the two groups in mechanical ventilation, indwelling peripherally inserted central catheter, parenteral nutrition, tracheal intubation, neonatal asphyxia, gestational age<37 weeks, birth weight<2.0 kg (P<0.05). Logistic regression analysis showed that gestational age<37 weeks [odds ratio (OR)=3.010, 95% confidence interval (CI) (1.489, 6.085), P=0.002], parenteral nutrition [OR=3.506, 95%CI (1.681, 7.312), P=0.001] were independent risk factors for LOS. The main clinical manifestations of LOS were abnormal temperature, feeding difficulties, jaundice, apnea, hypersensitive C-reactive protein and procalcitonin increase. The neonates with LOS were prone to necrotizing enterocolitis and purulent meningitis. A total of 74 pathogenic bacteria were cultured from neonates with LOS, including 49 Gram-positive bacterium, 21 Gram-negative bacteria and 4 fungi. The critical and death cases were mainly infected by Gram-negative bacteria. Conclusions A number of factors are related to LOS. Gestational age<37 weeks and parenteral nutrition are independent risk factors for LOS. In order to avoid LOS, attention should be paid to prevention, aseptic concept should be strengthened, and drugs should be used reasonably.

Citation： ZHANG Baohui, WANG Lili, QIAN Qingyan, ZHOU Chunrong. Risk factors and clinical characteristics of late-onset septicemia in neonates. West China Medical Journal, 2022, 37(9): 1334-1339. doi: 10.7507/1002-0179.202006256 Copy

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6.	Dong Y, Speer CP. Late-onset neonatal sepsis: recent developments. Arch Dis Child Fetal Neonatal Ed, 2015, 100(3): F257‐F263.
7.	劉慧強, 童笑梅. 極低/超低出生體重兒晚發敗血癥的臨床分析. 中國當代兒科雜志, 2019, 21(10): 1038‐1043.
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10.	Alcock G, Liley HG, Cooke L, et al. Prevention of neonatal late-onset sepsis: a randomised controlled trial. BMC Pediatr, 2017, 17(1): 98.
11.	El Manouni El Hassani S, Berkhout DJC, Niemarkt HJ, et al. Risk factors for late-onset sepsis in preterm infants: a multicenter case-control study. Neonatology, 2019, 116(1): 42‐51.
12.	Shaw AG, Sim K, Randell P, et al. Late-onset bloodstream infection and perturbed maturation of the gastrointestinal microbiota in premature infants. PLoS One, 2015, 10(7): e0132923.
13.	楚燕芳, 余加林, 杜立中. 區分早發型和晚發型新生兒敗血癥的臨床意義. 中華實用兒科臨床雜志, 2015, 30(10): 743-746.
14.	陳瀟, 富建華. 新生兒敗血癥 229 例臨床特點、病原學分布及轉歸分析. 中華實用兒科臨床雜志, 2019, 34(10): 740-744.
15.	Heida FH, Hulscher JB, Schurink M, et al. Bloodstream infections during the onset of necrotizing enterocolitis and their relation with the pro-inflammatory response, gut wall integrity and severity of disease in NEC. J Pediatr Surg, 2015, 50(11): 1837‐1841.
16.	Dong Y, Speer CP. The role of Staphylococcus epidermidis in neonatal sepsis: guarding angel or pathogenic devil?. Int J Med Microbiol, 2014, 304(5/6): 513-520.
17.	Heo JS, Shin SH, Jung YH, et al. Neonatal sepsis in a rapidly growing, tertiary neonatal intensive care unit: trends over 18 years. Pediatr Int, 2015, 57(5): 909‐916.
18.	Nour I, Eldegla HE, Nasef N, et al. Risk factors and clinical outcomes for carbapenem-resistant Gram-negative late-onset sepsis in a neonatal intensive care unit. J Hosp Infect, 2017, 97(1): 52‐58.
19.	崔雪薇, 薛辛東. 降鈣素原及 C-反應蛋白聯合檢測在新生兒院內感染早期診斷中的意義. 中國小兒急救醫學, 2016, 23(4): 222-226.
20.	Ree IMC, Fustolo-Gunnink SF, Bekker V, et al. Thrombocytopenia in neonatal sepsis: incidence, severity and risk factors. PLoS One, 2017, 12(10): e0185581.

1. Shane AL, Sánchez PJ, Stoll BJ. Neonatal sepsis. Lancet, 2017, 390(10104): 1770‐1780.
2. leischmann-Struzek C, Goldfarb DM, Schlattmann P, et al. The global burden of paediatric and neonatal sepsis: a systematic review. Lancet Respir Med, 2018, 6(3): 223‐230.
3. Wagstaff JS, Durrant RJ, Newman MG, et al. Antibiotic treatment of suspected and confirmed neonatal sepsis within 28 days of birth: a retrospective analysis. Front Pharmacol, 2019, 10: 1191.
4. 中華醫學會兒科學分會新生兒學組, 中國醫師協會新生兒科醫師分會感染專業委員會. 新生兒敗血癥診斷及治療專家共識(2019 年版). 中華兒科雜志, 2019, 57(4): 252-257.
5. 中華醫學會急診學分會兒科學組, 中華醫學會兒科學分會急診血組、新生兒學組. 新生兒危重病例評分法(草案). 中華兒科雜志, 2001, 39(1): 42-43.
6. Dong Y, Speer CP. Late-onset neonatal sepsis: recent developments. Arch Dis Child Fetal Neonatal Ed, 2015, 100(3): F257‐F263.
7. 劉慧強, 童笑梅. 極低/超低出生體重兒晚發敗血癥的臨床分析. 中國當代兒科雜志, 2019, 21(10): 1038‐1043.
8. Patel P, Bhatia J. Total parenteral nutrition for the very low birth weight infant. Semin Fetal Neonatal Med, 2017, 22(1): 2‐7.
9. Lapillonne A, Fidler Mis N, Goulet O, et al. ESPGHAN/ESPEN/ESPR/CSPEN guidelines on pediatric parenteral nutrition: lipids. Clin Nutr, 2018, 37(6 Pt B): 2324‐2336.
10. Alcock G, Liley HG, Cooke L, et al. Prevention of neonatal late-onset sepsis: a randomised controlled trial. BMC Pediatr, 2017, 17(1): 98.
11. El Manouni El Hassani S, Berkhout DJC, Niemarkt HJ, et al. Risk factors for late-onset sepsis in preterm infants: a multicenter case-control study. Neonatology, 2019, 116(1): 42‐51.
12. Shaw AG, Sim K, Randell P, et al. Late-onset bloodstream infection and perturbed maturation of the gastrointestinal microbiota in premature infants. PLoS One, 2015, 10(7): e0132923.
13. 楚燕芳, 余加林, 杜立中. 區分早發型和晚發型新生兒敗血癥的臨床意義. 中華實用兒科臨床雜志, 2015, 30(10): 743-746.
14. 陳瀟, 富建華. 新生兒敗血癥 229 例臨床特點、病原學分布及轉歸分析. 中華實用兒科臨床雜志, 2019, 34(10): 740-744.
15. Heida FH, Hulscher JB, Schurink M, et al. Bloodstream infections during the onset of necrotizing enterocolitis and their relation with the pro-inflammatory response, gut wall integrity and severity of disease in NEC. J Pediatr Surg, 2015, 50(11): 1837‐1841.
16. Dong Y, Speer CP. The role of Staphylococcus epidermidis in neonatal sepsis: guarding angel or pathogenic devil?. Int J Med Microbiol, 2014, 304(5/6): 513-520.
17. Heo JS, Shin SH, Jung YH, et al. Neonatal sepsis in a rapidly growing, tertiary neonatal intensive care unit: trends over 18 years. Pediatr Int, 2015, 57(5): 909‐916.
18. Nour I, Eldegla HE, Nasef N, et al. Risk factors and clinical outcomes for carbapenem-resistant Gram-negative late-onset sepsis in a neonatal intensive care unit. J Hosp Infect, 2017, 97(1): 52‐58.
19. 崔雪薇, 薛辛東. 降鈣素原及 C-反應蛋白聯合檢測在新生兒院內感染早期診斷中的意義. 中國小兒急救醫學, 2016, 23(4): 222-226.
20. Ree IMC, Fustolo-Gunnink SF, Bekker V, et al. Thrombocytopenia in neonatal sepsis: incidence, severity and risk factors. PLoS One, 2017, 12(10): e0185581.

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