早期新生儿感染相关影响因素1:1配对病例对照研究

发布时间：2018-10-19 16:50

【摘要】：目的:明确本中心早期新生儿感染的高危因素,为其临床管理提供理论依据。方法:收集2013年1月至2015年12月吉林大学第一医院新生儿科生后3天内合并感染(包括新生儿感染、新生儿败血症、化脓性脑膜炎)的441例新生儿作为病例组,并按1:1比例在同期住院生后3天内无感染同性别及胎龄的新生儿中随机抽取441例作为对照组。根据既往文献资料中早期新生儿感染(early onset neonatal infection,EONI)的影响因素设计成调查表对既往病例进行信息采集,内容包括与EONI相关的孕母史、新生儿出生时及生后一般情况。应用SPSS21.0软件对EONI相关因素进行单因素及多因素统计分析,明确EONI的高危因素。结果:(1)一般信息:441对新生儿,男性246对(55.8%),女性195对(44.2%),病例组胎龄34.19(31~38)周,对照组胎龄34.20(31~38)周。病例组中新生儿感染335例(76.0%,335/441),化脓性脑膜炎5例(1.1%,5/441),新生儿败血症101例(22.9%,101/441),其中血培养阳性40例(39.6%,40/101),病原体种类繁多,革兰氏阳性葡萄球菌18例(45%,18/40),革兰氏阴性杆菌13例(32.5%,13/40),革兰氏阳性链球菌5例(12.5%,5/40),革兰氏阳性杆菌3例(7.5%,3/40),白假丝酵母菌1例(2.5%,1/40),常见致病菌有:大肠埃希菌7例(17.5%,7/40)、金黄色葡萄球菌5例(12.5%,5/40)、表皮葡萄球菌3例(7.5%,3/40)、人葡萄球菌人亚种3例(7.5%,3/40)。(2)单因素分析结果:胎膜早破(Premature rupture of membranes,PROM)18h、羊水粪染、孕母产前发热、产前应用抗生素、极低出生体重儿(very low birth weight,VLBW)、生后窒息、生后3天内发热、新生儿出血性疾病、生后24小时内白细胞计数异常(5.0×109/L或25×109/L)及血小板计数降低(150×109/L)是EONI的相关危险因素。(3)多因素回归分析:PROM18h、羊水粪染、VLBW、孕母产前发热、生后3天内发热、生后24小时内白细胞计数异常(5.0×109/L或25×109/L)及血小板计数降低(150×109/L)是EONI的独立危险因素。结论:(1)本中心EONI的血培养阳性率低,病原体种类繁多,以革兰氏阳性葡萄球菌和革兰氏阴性杆菌为主,常见致病病原菌包括:大肠埃希菌、金黄色葡萄球菌、表皮葡萄球菌、人葡萄球菌人亚种。(2)PROM18h、羊水粪染、孕母产前发热、产前应用抗生素、VLBW、生后3天内发热、新生儿出血性疾病、生后24小时内白细胞计数异常及血小板计数降低是EONI的相关危险因素。(3)PROM18h、羊水粪染、VLBW、孕母产前发热、生后发热、生后24小时内白细胞计数异常及血小板计数降低是EONI的独立危险因素。
[Abstract]:Objective: to identify the high risk factors of early neonatal infection in our center and provide theoretical basis for clinical management. Methods: from January 2013 to December 2015, 441 newborns with neonatal infection (including neonatal infection, neonatal septicemia, suppurative meningitis) in the first Hospital of Jilin University were collected as the case group. At 1:1, 441 newborns of the same sex and gestational age were randomly selected as control group. According to the influencing factors of early neonatal infection with (early onset neonatal infection,EONI in the past literature, the information of past cases was collected by questionnaire, including the maternal history related to EONI, the general situation of newborn at birth and postnatal. Univariate and multivariate statistical analysis of EONI related factors was carried out with SPSS21.0 software to identify the high risk factors of EONI. Results: (1) General information: 441 pairs of newborns, 246 pairs of males (55.8%) and 195 pairs of females (44.2%), the gestational age of the case group was 34.19 (31 / 38) weeks, and that of the control group was 34.20 (31 / 38) weeks. There were 335 cases of neonatal infection (76.0% 335% 441), 5 cases of suppurative meningitis (1.1% / 441), 101 cases of neonatal septicemia (22.9% / 441), 40 cases of positive blood culture (39.6% 40 / 101), and a variety of pathogens. There were 18 Gram-positive staphylococci, 13 Gram-negative bacilli, 5 Gram-positive streptococcus, 3 Gram-positive bacilli, 3 Gram-positive bacilli, 1 Saccharomyces albicans (2.555 / 40), 7 Escherichia coli, 17.575 / 40. There were 5 cases of staphylococcus (12.5%), 3 cases of Staphylococcus epidermidis (7.5%), 3 cases of human staphylococcus human subspecies (7.5% 40). (2). The results of univariate analysis were as follows: premature rupture of membranes, (Premature rupture of membranes,PROM, 18 h, feces stained with amniotic fluid. Prenatal fever, prenatal antibiotics, very low birth weight (very low birth weight,VLBW), postnatal asphyxia, fever within 3 days of birth, neonatal hemorrhagic disease, Abnormal white blood cell count (5.0 脳 10 9 / L or 25 脳 10 9 / L) and decreased platelet count (150 脳 10 9 / L) in 24 hours after birth were related risk factors of EONI. (3) Multivariate regression analysis: PROM18h, meconium staining, prenatal fever in pregnant women with VLBW, fever within 3 days after birth. Abnormal leukocyte count (5.0 脳 109 / L or 25 脳 109 / L) and decreased platelet count (150 脳 109 / L) were independent risk factors for EONI. Conclusion: (1) the positive rate of blood culture of EONI in our center is low, and there are many kinds of pathogens, mainly Gram-positive Staphylococcus and Gram-negative bacilli. The common pathogenic bacteria include Escherichia coli, Staphylococcus aureus, Staphylococcus epidermidis, and Staphylococcus epidermidis. Human staphylococcus human subspecies. (2) feces stained with PROM18h, amniotic fluid, prenatal febrile pregnancy, antepartum application of antibiotics, fever within 3 days after birth of VLBW, hemorrhagic disease of newborn, Abnormal white blood cell count and decreased platelet count within 24 hours after birth were related risk factors of EONI. (3) PROM18h, amniotic fluid faecal staining, prenatal fever of VLBW, pregnant mother, postnatal fever, Abnormal leukocyte count and decreased platelet count within 24 hours after birth were independent risk factors for EONI.
【学位授予单位】：吉林大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R722.13

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