| Objective:The purpose of this article is to compare and contrast the differences between early-onset and late-onset neonatal sepsis with regards to various factors such as general conditions,clinical manifestations,complications,laboratory test data,prognosis,and etiology.The intention is to offer valuable information to aid in the diagnosis,treatment,and prognosis evaluation of neonatal sepsis.Methods:A retrospective study design was used to divide the children into two groups according to the time of onset.Early-onset neonatal septicemia(EOS)refers to sepsis occurring within three days after birth,while late-onset neonatal septicemia(LOS)refers to sepsis occurring after three days after birth.The case data of 217 cases of neonatal sepsis admitted to Yuncheng Central Hospital from January 1,2016 to May 31,2022 were collected and statistically analyzed for general conditions,clinical features and complications,relevant laboratory test data,outcome of transition and pathogenic related conditions by grouping the children according to their date of onset.Results:1.A total of 217 case data were collected,71 children with LOS and 146 children with LOS were included in this study.There was no significant difference between the two groups of children in terms of gender and mode of delivery(P<0.05),with more males and infants delivered by cesarean section.Preterm infants were more frequent in the LOS group and full-term infants in the EOS group,and the difference in gestational age was statistically significant in both groups(χ~2 value 32.97,P<0.05).median 2900 g for EOS(2300,3300)and 1885 g for LOS(1307.5,2752.5),BW was statistically significant between the two groups(Z=-5.831,P<0.001);there was no statistical difference in perinatal factors,P>0.05;The number of mechanical ventilation,tracheal intubation,CPAP,PICC,UAC/UVC,lumbar puncture,and thoracic puncture in the LOS group were all performed in greater numbers than the EOS group,and all of them were statistically significant except thoracentesis(5 cases,2.3%)(χ~2 values 20.578,32.444,14.352,30.722,-,6.749,P<0.05);2.Among the clinical manifestations,the difference in the statistics of the number of cases of poor nausea,poor response,lethargy,oedema,sclerosis,fever and glycaemic abnormalities was statistically significant between the two groups(χ~2 values8.682,8.404,5.849,12.115,5.206,P<0.05);the number of complications was significantly higher in the LOS group than in the EOS group,including anaemia,RDS,neonatal lung inflammation,BPD,internal environmental disorders,hypoproteinemia,organ bleeding disorders,clotting disorders and capillary leakage in nine groups,and this difference was statistically significant(χ~2 10.348,7.594,4.524,41.151,28.787,21.344,29.219,5.943,4.524,P<0.05).3.There were more cases of abnormal WBC count,high PCT values,and high CRP values in the LOS group than in the EOS group,and the differences were statistically significant(χ~2 4.825,87.220,4.523,P<0.05).These laboratory indicators can be used as an auxiliary reference basis to determine whether the two groups of children have the disease or not,and the rate of positive auxiliary diagnostic abnormalities is not high.4.There was no significant difference between the results of the two groups of children’s regression,P>0.05;the magnitude of change in each outcome was not significant in children of different generations.the length of hospitalization was longer in the LOS group and was statistically different(Z=-3.004,P<0.05).5.Of the 217 valid case data collected,a total of 52 positive cases were cultured,with a positivity rate of approximately 24.0%.Among them,32 positive cases(21.9%)in the EOS group were more than 20 cases(28.1%)in the LOS group,which was statistically significant(χ~2 1.024,P<0.05);a total of 62 pathogenic bacteria were found,34 cases(54.8%)in G+,23 cases(37.1%)in G-,and 5 cases(8.1%)in fungi,and 32 cases in the LOS group were cultured The difference between the two groups was statistically significant(χ~2 6.868,P<0.05),with 2 or more strains of bacteria cultured in some samples,and the possibility of multiple pathogenic bacteria infection was greater in the LOS group;both the LOS and EOS groups were dominated by G+ were predominant,and the number of G-in the EOS group was greater than that in the LOS group,which was not statistically significant,P>0.05;the incidence of LOS in the fungal group was high and statistically significant(χ~23.676,P<0.05);in the LOS group G+ Staphylococcus epidermidis(10 cases,47.6%),G-Onion Burkholderia cepacia(3 cases,27.3%),and no fungi were found;G-Klebsiella pneumoniae(4 cases,33.3%)and G+ Staphylococcus aureus(3 cases,23.1%)were more common in the EOS group,and the fungus Candida albicans(2 cases,40.0%)was the most common;the different locations of the collected specimens did not have a statistical difference,P>0.05,with the highest number of pathogenic bacteria cultured in blood;.5.1 There were only 7 strains of pathogens identified in the previous 3 years(11.3%),which is significantly less than the 55 strains identified in the latter 4 years(88.7%).The quantity of G+,G-,and fungi in 2016-2021 showed an overall increasing trend.5.2 In the G+ group,one case(33.3%)of Streptococcus haemolyticus in group B was a multi-drug resistant organism.For penicillin G,5 cases(45.5%)of Staphylococcus epidermidis showed the strongest resistance.In the G-group,all 2 cases of Escherichia coli were multi-drug resistant and Burkholderia cepacia showed the strongest resistance to ceftazidime(60% of the 3 cases).In Candida smoothus,Candida albicans and Pseudomonas albicans,no resistance was found to be present.Conclusion:1.In the last 7 years,the main manifestation of NS in our hospital has been LOS,with EOS mostly seen in full-term normal BW infants and LOS mostly seen in preterm low BW infants.Maternal and infant perinatal period was not found to influence the different types of neonatal sepsis in our hospital,while the treatment measures during hospitalization had a significant impact on the management of the disease.Lower morbidity and mortality rates and higher cure rates in the present study;2.There are no distinctive features in terms of clinical symptoms and complications in neonates with sepsis,which are diverse and complex,but there is a slight difference in the incidence of some of them in EOS and LOS.the WBC count,PCT value and CRP value can be used as auxiliary diagnostic reference indicators;3.G+ was detected in the largest number,and some children had multiple bacteria infected at the same time,mostly in the LOS group.The number of all types of organisms detected has generally shown an increasing trend in recent years;4.The choice of antibiotics should be combined with the local pathogenic bacteria spectrum and drug resistance characteristics. |
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