Abstract: 【Abstract】 Objective To retrospective study the clinical manifestations and prognosis of neonates with early-onset and late-onset sepsis, investigate the early diagnosis and treatment of neonatal septicemia. Method From January 2015 to December 2020, the neonates with sepsis (all blood cultures were positive)were retrospectively analyzed in Pediatric department of the Fifth Medical Center of PLA General Hospital.According to the onset time, they were divided into EOS group( onset ≤ 72 h after birth, n=60) and LOSgroup (onset >72 h after birth, n=43).The basic condition, onset symptoms, pathogen distribution, laboratorydetection and prognosis of EOS group and LOS group were analyzed and compared. Statistical methodsperformed by t-test, rank sum test and χ2-test. Result A total of 103 cases with sepsis (all blood cultureswere positive) were selected in the study, including 60 cases in the EOS group (58.2%) and 43 cases in theLOS group (41.7%).The incidence of amniotic fluid contamination [36.7% (22/60) vs 7.0% (3/43)] andmaternal fever [15.0% (9/60) vs 2.3% (1/43)] at birth in EOS group were higher than those in LOS group(χ2=12.013, 4.590, P<0.05).The proportion of premature infants [79.1% (34/43) vs 18.3% (11/60)] and lowbirth weight infants [62.8%(27/43) vs 20.0% (12/60)] in LOS group were higher than those in EOS group(χ2=37.558, 19.494, P<0.05).The incidence of dyspnea [51.7% (31/60) vs 16.3% (7/43)] in EOS group washigher than that in LOS group (χ2=13.473, P<0.05). The incidence of apnea [16.3% (7/43) vs 1.7% (1/60)],poor reaction [34.9% (15/43) vs 5.0% (3/60)], abnormal blood glucose [14.0% (6/43) vs 1.7% (1/60)] andskin fluttering [14.0% (6/43) vs 3.3% (2/60)] in LOS group were higher than those in EOS group (χ2=7.466,15.511, 5.970, 3.944, all P<0.05).The incidence of leukopenia (white blood count < 5×109/L) [30.2% (13/43)vs 5.0%(3/60)] in LOS group was significantly higher than that in EOS group (χ2=5.85, P<0.05). Serumlevels of CRP and PCT in LOS group were significantly higher than those in EOS group (Z=-2.01, -2.35,P<0.05). In the EOS group, Gram-positive bacteria were the most prevalent, accounting for 40 cases (66.6%),including 14 cases of Staphylococcus epidermidis and 6 cases of Listeria in the top two. In LOS group, Gramnegativebacteria were the most prevalent, accounting for 35 cases (81.3%), with 17 cases of Escherichia coliand 7 cases of Klebsiella pneumoniae in the top two. There was no significant difference in the complicationsand outcomes of sepsis between the two groups (P>0.05). Conclusion There are some differencesbetween early-onset and late-onset neonatal sepsis. Most cases of EOS are caused by gram-positive bacteria,and most are caused by Staphylococcus epidermidis. Most cases of LOS were infected with gram-negativebacteria, and most are infected with escherichia coli. Amniotic fluid contamination and prenatal fever are highrisk factors for EOS, and dyspnea is a common symptom after onset. Distinguishing EOS and LOS can guiderational drug use of neonatal sepsis with unknown pathogenic bacteria.
2022, Vol. 10 
