Особливості лікувальної тактики за неонатального сепсису залежно від запальної відповіді організму

Abstract

Purpose - to conduct a comparative analysis of the effectiveness of etiotropic treatment and supporting therapy of infants with neonatal sepsis with an alternative content of C-reactive protein in the blood serum to improve individualized therapy of generalized infectious and inflammatory diseases in the newborn period. Materials and methods. A comprehensive examination of 56 newborns suffering from neonatal sepsis the 1st, 3rd and 7th days of the disease. The Group I included 25 patients with neonatal sepsis with a serum C-reactive protein level <20 mg/l, and the Group II included 31 newborns with sepsis with a serum C-reactive protein level >20 mg/l. Determination of the content of C-reactive protein in blood serum (mg/l) was carried out by the method of immunoenzymatic analysis on the «StatFax 303 / Plus» device. The obtained results were analyzed by methods of descriptive statistics, biostatistics and clinical epidemiology. Fisher’s exact test (Pφ) and Student’s test were used for statistical processing; the results were significant at p<0.05 with a tendency to significance - at p=0.05-0.1. Results. It was established that in 20.0% of newborns of the Group I and in 11.4% of patients of the Group II (Рφ>0.05), etiotropic treatment was changed due to insufficient effectiveness of the previous two courses. Patients of the Group I had a higher risk of needing to re-review the composition of antibiotic therapy: odds ratio (OR) = 1.9 (95% confidence interval (95% CI): 0.8-4.3), attributive risk (AR) = 16.0%. Practically all patients of the Group I were on oxygen support, the risk of this event was significantly higher for them compared to children of the Group II: OR=2.7 (95% CI: 1.2-6.6). Newborns of the Group II compared to babies of the Group I received inpatient treatment for less time, their chances of being discharged from the hospital before the 20th day were probably higher: OR=5.7 (95% CI: 1.85-17.32). The better effectiveness of the standard treatment of sepsis of newborns in the Group II in terms of the frequency of discharge from the hospital up to 20 days is demonstrated by a decrease in the AR of event realization, which is 15.4%. Conclusions. Patients of the Group I twice as often received the third course of antibiotic therapy. Infants of the Group II more often needed combined antibacterial therapy with a slightly shorter course and also recovered faster with discharge of every fifth baby by the 20th day. Against the background of a relatively higher content of C-reactive protein in blood serum, the standard treatment of newborns is more effective and allows for a 79.3% increase in the relative risk of rapid recovery at the same time, the minimum number of treated patients - 1.3. The research was carried out in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the institution mentioned in the work. The informed consent of the children's parents was obtained for the conducting the studies. No conflict of interests was declared by the authors.