| Objective:To investigate the clinical features and risk factors of community-acquired late-onset neonatal sepsisMethods:Use retrospective study to choose Shenzhen Children’s Hospital between January 2017 and December 2019 community acquired late-onset neonatal sepsis,a total of 127 cases,and according to the illness severity and critically ill newborn score divided into mild group(101 cases)and severe group(26 cases),collecting the clinical data were retrospectively analyzed,and corresponding using single factor analysis comparing two groups of general situation,clinical manifestations,complications,and laboratory indexes,such as the binary classification multiariable logistic regression analysis of community acquired late onset neonatal sepsis,severe degree of predictors,ROC curve drawing.Results:127 cases of community acquired late-onset neonatal sepsis included 101cases in mild group and 26 cases in severe group(including 8 deaths).Among them,38 cases(29.9%)were positive in blood culture,26 cases(68.4%)were Gram-positive bacteria,and most of them were coagulase-negative staphylococcus.Gram-negative bacteria were found in 12 cases(31.6%),and Escherichia coli was the main strain.In univariate analysis,slow daily weight gain before admission,ALB<35g/L,WBC<5×10~9/L,PLT<100×10~9/L,shock,neonatal necrotizing enterocolitis,neonatal respiratory failure,pulmonary hypertension and coagulation dysfunction may be related to the severity of the disease(P< 0.05).Multivariate logistic regression analysis showed that body temperature<37.3℃(OR52.331,95%CI 7.212～379.7),ALB<35g/L(OR42.464,95%CI 2.654～679.321)and WBC<5×10~9/L(OR14.209,95%CI 2.493～80.975)were independent risk factors for severe neonatal sepsis with community acquired late onset(P<0.05).Rapid daily weight gain before admission(OR0.97,95%CI 0.945～0.995)may be a protective factor for community acquired late-onset neonatal sepsis.The predictive efficacy of ALB was the highest when a single index was used to predict the severity of community acquired late-onset neonatal sepsis.The AUC of ALB was 0.843(95%confidence interval 0.746～0.94,P<0.05),the optimal cutoff value was 31.25g/L,the sensitivity was 80.8%,and the specificity was 82.2%.Conclusion:Body temperature<37.3℃,ALB<35g/L and WBC<5×10~9/L were risk factors for severe community acquired late-onset neonatal sepsis.Rapid daily weight gain before admission was a protective factor for community-acquired late-onset neonatal sepsis.An ALB lower than 31.25 g/L on admission indicates a high likelihood of severity of community-acquired late-onset neonatal sepsis. |
