新生儿败血症死亡病例的临床分析

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摘要目的分析早发败血症（EOS）及晚发败血症（LOS）新生儿死亡病例的临床特点。方法回顾性分析2016年1月至2020年12月广东省妇幼保健院新生儿科住院且死亡原因为新生儿败血症的病例资料。根据发病时间将其分为EOS组（38例）和 LOS组（46例），比较两组的基本资料（性别、出生胎龄、出生体重、围生期相关因素）及临床特点（败血症相关检验结果、合并症的发生情况）。结果两组性别、出生胎龄、早产、出生体重、超低出生体重儿、小于胎龄儿、剖宫产比较，差异无统计学意义（P > 0.05）。EOS组发病至死亡时间短于LOS组，差异有统计学意义（P ＜ 0.05）。两组胎膜早破≥18 h、羊水Ⅲ度污染、胎儿窘迫、母亲年龄＞35岁、母亲绒毛膜羊膜炎、母亲孕后期感染发生率比较，差异无统计学意义（P > 0.05）。EOS组肺炎克雷伯菌检出率低于LOS组；EOS组白细胞计数（WBC）<5×109/L、WBC升高发生率低于LOS组，差异有统计学意义（P < 0.05）。两组血小板计数（PLT）<100×109/L、PLT≤30×109/L、C反应蛋白≥100 mg/L、降钙素原≥30 ng/ml发生率及B族链球菌、大肠埃希菌检出率比较，差异无统计学意义（P > 0.05）。EOS组新生儿坏死性小肠结肠炎发生率低于LOS组，围生期窒息发生率高于LOS组，差异有统计学意义（P < 0.05）。两组细菌性脑膜炎、感染性肺炎、新生儿高血糖症、新生儿低血糖症、新生儿肺出血发生率比较，差异无统计学意义（P > 0.05）。结论新生儿期EOS和LOS导致死亡的高危因素不同、病原体不同、合并症也有差异，在临床工作应引起重视。

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	颜慧恒1 李晖2 何倩敏1 王艳丽1 陈运彬1

关键词 ：早发败血症, 晚发败血症, 新生儿, 死亡

Abstract：Objective To analyze the clinical characteristics of neonatal deaths with early-onset sepsis (EOS) and late-onset sepsis (LOS). Methods Data of neonatal sepsis cases hospitalized in Department of Neonatology, Guangdong Women and Children Hospital from January 2016 to December 2020 were retrospectively analyzed. According to the time of onset, they were divided into EOS group (38 cases) and LOS group (46 cases). Basic data (gender, gestational age, birth weight, perinatal related factors) and clinical characteristics (sepsis related test results, the incidence of complications) were compared between two groups. Results There were no significant differences in gender, gestational age, preterm, birth weight, extremely low birth weight infant, small for gestational age, cesarean section between two groups (P >0.05). The time from onset to death in EOS group was shorter than that in LOS group, and the difference was statistically significant (P < 0.05). There were no significant differences in the incidence of premature rupture of membranes ≥18 h, Ⅲ degree contamination of amniotic fluid, fetal distress, maternal age > 35 years old, maternal chorionic amniotis, and maternal infection in late pregnancy between two groups (P > 0.05). The detection rate of Klebsiella pneumoniae in EOS group was lower than that in LOS group; white blood cell count (WBC) <5×109/L and the incidence of WBC increase in EOS group were lower than those in LOS group, and the differences were statistically significant (P < 0.05). There were no significant differences in the incidence of platelet count (PLT) <100×109/L, PLT≤30×109/L, C-reactive protein ≥100 mg/L, procalcitonin ≥30 ng/ml and detection rate of group B streptococcus, Escherichia coli between two groups (P > 0.05). The incidence of neonatal necrotizing enterocolitis in EOS group was lower than that in LOS group, and the incidence of perinatal asphyxia was higher than that in LOS group, and the differences were statistically significant (P < 0.05). There were no significant differences in the incidence of bacterial meningitis, infectious pneumonia, neonatal hyperglycemia, neonatal hypoglycemia, and neonatal pulmonary hemorrhage between two groups (P > 0.05). Conclusion EOS and LOS in neonatal period have different risk factors, pathogens and complications, which should be paid more attention in clinical work.

Key words： Early-onset sepsis Late-onset sepsis Neonatal Death

基金资助:广东省科技计划项目（2017ZC0322）。

通讯作者: 陈运彬（1961-），男，硕士，主任医师；研究方向：新生儿危重症抢救。

作者简介: 颜慧恒（1985-），女，硕士；研究方向：新生儿危重症抢救。

引用本文:

颜慧恒1 李晖2 何倩敏1 王艳丽1 陈运彬1. 新生儿败血症死亡病例的临床分析[J]. 中国医药导报, 2021, 18(23): 84-87,103.
YAN Huiheng1 LI Hui2 HE Qianmin1 WANG Yanli1 CHEN Yunbin1. Clinical analysis of neonatal sepsis deaths. 中国医药导报, 2021, 18(23): 84-87,103.

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https://www.yiyaodaobao.com.cn/CN/ 或 https://www.yiyaodaobao.com.cn/CN/Y2021/V18/I23/84

[1] Fleischmann-Struzek C，Goldfarb DM，Schlattmann P，et al. The global burden of paediatric and neonatal sepsis：a systematic review [J]. Lancet Respir Med，2018，6（3）：223-230.
[2] GBD 2015 Mortality and Causes of Death Collaborators. Global，regional，and national life expectancy，all-cause mortality，and cause-specific mortality for 249 causes of death，1980-2015：a systematic analysis for the Global Burden of Disease Study 2015 [J]. Lancet，2016，388（10053）：1459-1544.
[3] 中华医学会儿科学分会新生儿学组，中国医师协会新生儿科医师分会感染专业委员会.新生儿败血症诊断及治疗专家共识（2019年版）[J].中华儿科杂志，2019，57（4）：252-257.
[4] 邵肖梅，叶鸿瑁，丘小汕.实用新生儿学[M].5版.北京：人民卫生出版社，2019.
[5] Allanson ER，Tun?觭alp ?魻，Gardosi J，et al. Giving a voice to millions：developing the WHO application of ICD-10 to deaths during the perinatal period：ICD-PM [J]. BJOG，2016，123（12）：1896-1899.
[6] Liu L，Oza S，Hogan D，et al. Global，regional，and national causes of child mortality in 2000-13，with projections to inform post-2015 priorities：an updated systematic analysis [J]. Lancet，2015，385（9966）：430-440.
[7] Stoll BJ，Hansen NI，Sánchez PJ，et al. Early onset neonatal sepsis：the burden of group B Streptococcal and E. coli disease continues [J]. Pediatrics，2011，127（5）：817-826.
[8] Schrag SJ，Farley MM，Petit S，et al. Epidemiology of Invasive Early-Onset Neonatal Sepsis，2005 to 2014 [J]. Pediatrics，2016，138（6）：e20162013.
[9] Ely DM，Driscoll AK. Infant Mortality in the United States，2017：Data From the Period Linked Birth/Infant Death File [J]. Natl Vital Stat Rep，2019，68（10）：1-20.
[10] Achten NB，Juliana AE，Lissone NP，et al. Epidemiology and Mortality of Early-Onset Neonatal Sepsis in Suriname：A 2-Year Surveillance Study [J]. J Pediatric Infect Dis Soc，2020，10（4）：514-516.
[11] Dain C，Rozé JC，Caillon J，et al. Epidemiology of invasive early-onset neonatal infection in a French administrative district：A 10-year population-based study [J]. Arch Pediatr，2020，27（7）：356-361.
[12] He C，Liu L，Chu Y，et al. National and subnational all-cause and cause-specific child mortality in China，1996-2015：a systematic analysis with implications for the Sustainable Development Goals [J]. Lancet Glob Health，2017，5（2）：e186-e197.
[13] K?觟stlin-Gille N，H?覿rtel C，Haug C，et al. Epidemiology of Early and Late Onset Neonatal Sepsis in Very Low Birthweight Infants：Data From the German Neonatal Network [J]. Pediatr Infect Dis J，2021，40（3）：255-259.
[14] 王雪莲，陈超.中国新生儿死亡原因变迁[J].中华围产医学杂志，2014，17（6）：425-427.
[15] Phares CR，Lynfield R，Farley MM，et al. Epidemiology of invasive group B streptococcal disease in the United States，1999-2005 [J]. JAMA，2008，299（17）：2056-2065.
[16] Bizzarro MJ，Raskind C，Baltimore RS，et al. Seventy-five years of neonatal sepsis at Yale：1928-2003 [J]. Pediatrics，2005，116（3）：595-602.
[17] Singh T，Barnes EH，Isaacs D，Australian Study Group for Neonatal Infections. Early-onset neonatal infections in Australia and New Zealand，2002-2012 [J]. Arch Dis Child Fetal Neonatal Ed，2019，104（3）：F248-F252.
[18] Lu L，Li P，Pan T，et al. Pathogens Responsible for Early-Onset Sepsis in Suzhou，China [J]. Jpn J Infect Dis，2020， 73（2）：148-152.
[19] 程琳，徐发林，牛铭，等.早产儿败血症的病原体及其临床特征[J].中国当代儿科杂志，2019，21（9）：881-885.
[20] Gao K，Fu J，Guan X，et al. Incidence，Bacterial Profiles，And Antimicrobial Resistance Of Culture-Proven Neonatal Sepsis In South China [J]. Infect Drug Resist，2019， 12：3797-3805.
[21] 任建兵，李慈梅，王芳，等.新生儿B族链球菌败血症早发型和晚发型临床特征分析[J].中华新生儿科杂志：中英文，2018，33（2）：118-121.
[22] 马海燕，林广，黄辉文，等.早发型和晚发型新生儿B族链球菌败血症临床分析[J].中华新生儿科杂志，2020， 35（4）：292-295.
[23] 杜彩容，胡瑾，罗剑婷.妊娠中晚期孕妇B族溶血性链球菌感染率及其对母婴结局的影响[J].中国当代医药，2019，26（16）：161-164.
[24] Jatsho J，Nishizawa Y，Pelzom D，et al. Clinical and Bacteriological Profile of Neonatal Sepsis：A Prospective Hospital-Based Study [J]. Int J Pediatr，2020，2020：1835945.
[25] Gebremedhin D，Berhe H，Gebrekirstos K. Risk Factors for Neonatal Sepsis in Public Hospitals of Mekelle City，North Ethiopia，2015：Unmatched Case Control Study [J]. PLoS One，2016，11（5）：e0154798.
[26] Rafi MA，Miah MMZ，Wadood MA，et al. Risk factors and etiology of neonatal sepsis after hospital delivery：A case-control study in a tertiary care hospital of Rajshahi，Bangladesh [J]. PLoS One，2020，15（11）：e0242275.
[27] Wu IH，Tsai MH，Lai MY，et al. Incidence，clinical features，and implications on outcomes of neonatal late-onset sepsis with concurrent infectious focus [J]. BMC Infect Dis，2017，17（1）：465.