Clinical characteristics of early death of 16 cases with early-onset neonatal septicemia and factors for death

Abstract

Objective To study the characteristics and risk factors of infants early onset sepsis(EOS) in infants which resulted in death. Methods Among the infants admitted to the Maternal and Child Health Hospital of Guangxi Zhuang Autonomous from Jan.2000 to Jun.2013, the EOS cases died during the first week were chosen as the mortality group, while the survival babies who were attacked with EOS admitted during the same months as the control group.Their clinical records were collected and analyzed. Results Sixteen cases of the mortality group and 54 cases of the survival group were included.The cases of maternal infection-related fever in the mortality group were more than those in the control group[7 cases(44%) in the mortality group and 4 cases(7%) in the control group], there was statistical difference(P=0.002). Furthermore, other maternal factors and delivery situations were compared between the mortality group and the survival group, such as maternal age[(29.8±8.2) years old, (28.2±6.0) years old], city inhabitants[12 cases(75%), 40 cases(74%)], assisted reproduction[2 cases(12%), 5 cases(9%)], cesarean section[4 cases(25%), 10 cases(19%)], preeclampsia[2 cases(13%), 16 cases(30%)], maternal diabetes[2 cases(13%), 5 cases(9%)], intrauterine distress[6 cases(38%), 23 cases(43%)], premature rupture of membrane[4 cases(25%), 16 cases(30%)], intrauterine infection[14 cases(88%), 37 cases(69%)], chorioamnionitis[10 cases(63%), 33 cases(61%)], placental dysfunction[6 cases(38%), 16 cases(30%)], gestational age[(36.8±1.7) weeks, (37.5±1.6) weeks], birth weight[(2 695.9±688.6) g, (2 895.8±466.8) g], intrauterine growth retarded[3 cases(19%), 7 cases(13%)]and neonatal asphxia[7 cases(13%), 6 cases(11%)], which were not statistically different.The similar statistical finding included the following: the diagnosis of patent ductus arteriosis(PDA)[5 cases(31%), 7 cases(13%)]and the result of blood nature such as escherichia coli[10 cases(63%), 34 cases(63%)], E.coli[7 cases(44%), 19 cases(35%)], klebsiella pneumoniae[8 cases(50%), 24 cases(44%)], pseudomonas aeruginosa[6 cases(38%), 15 cases(28%)], staphylococcus aureus[4 cases(25%), 9 cases(18%)], staphylococcus epidermidis[5 cases(31%), 9 cases(17%)], staphylococcus hominis[3 cases(19%), 3 cases(6%)], other coagulase negative staphylococcus(CNS)[5 cases(31%), 12 cases(22%)], lactococcus[4 cases(25%), 8 cases(15%)], candida albicans[2 cases(13%), 5 cases(9%)], other fungi[2 cases(13%), 8 cases(15%)]. However, the discrepancies between the mortality group and the control group on diagnosis included necrotizing enterocolitis(NEC)[10 cases(63%), 17 cases(32%)], acute lung injure(ALI)[8 cases(50%), 11 cases(20%)], pulmonary haemorrhage[6 cases(38%), 3 cases(6%)], disseminated intravascular coagulation(DIC) [9 cases(56%), 11 cases(20%)], which had statistical significance(respectively, P=0.025, 0.043, 0.003, 0.013). According to Logistic regression, maternal fever, NEC, pulmonary hemorrhage, DIC were the relative risk factors in statistics(P=0.030, 0.021, 0.024, 0.033). Conclusions Acute maternal infection-related fever is likely to be the risk factors for mortality in the infants attacked with EOS, and no differentiation between the 2 groups was found in respect with pathogen.Furthermore, complicated with NEC, ALI, pulmonary haemorrhage and DIC are the irreversible risk factors for babies with EOS. Key words: Early onset sepsis; Infant, newborn; Immunity system; Systemic inflammatory response