Baizat Melinda, Zaharie Gabriela, Iancu Mihaela, Muresan Daniel, Hășmășanu Monica, Procopciuc Lucia M
Clin Lab. 2019 Jul 1;65(7). doi: 10.7754/Clin.Lab.2019.190105.
Neonatal sepsis represents one of the common diseases in the neonatal intensive care unit. Here we aim to evaluate the differences between a group of preterm newborns with sepsis and a control group in relation to clinical and laboratory variables. In addition, our goal is to establish potential predictors of early-onset sepsis (EOS) and late-onset sepsis (LOS).
The study included 113 preterm newborns with sepsis (EOS-63.72%/LOS-36.28%). Laboratory deter-minations included full blood count, CRP, biochemical determinations, blood culture.
The most important univariate neonatal predictors were gestational age (p < 0.001), surfactant adminis-tration (p < 0.001), mechanical ventilation (p < 0.001), heart failure (p < 0.001), a history of hypocalcemia (p = 0.037), Apgar score at 1 minute lower than 7 (p = 0.001), birth weight < 1,500 g (p = 0.005), number of hospi-talization days (p = 0.048), and number of weight recovery days < 10 (p < 0.05). The WBC and CRP parameters remained significant univariate predictors of sepsis on day 7 (p = 0.002; OR = 2.01 per 10,000 mm3 increase of WBC, 95% CI: (1.30; 3.09) and p = 0.001; OR = 4.27, 95% CI: (1.85; 9.88), respectively). Logistic regression anal-ysis showed maternal urinary tract infection (OR = 3.05), heart failure (OR = 5.28), the number of hospitalization days (OR = 1.09) and CRP (OR = 3.26) were significant independent risk factors for neonatal sepsis in preterms. The univariate predictors of EOS were gestational age (p = 0.002), birth weight (p = 0.014), 1-minute Apgar score (p = 0.012), maternal urinary tract infection (p = 0.008), surfactant administration (p < 0.001), heart failure (p < 0.001), and CRP level (p < 0.001). Surfactant administration (OR = 6.73) and CRP level (OR = 3.51) represent predictors of EOS in preterms according to the multivariate model. The univariate predictors of LOS were gesta-tional age (p = 0.001), birth weight (p = 0.048), 1-minute Apgar score (p = 0.001), surfactant administration (p < 0.001), hypocalcemia (p = 0.03), heart failure (p = 0.003), CRP level (p < 0.001), mechanical ventilation (p < 0.001), and the number of hospitalization days (p < 0.001). In the multivariate model, the number of hospitali-zation days (OR = 1.11) and heart failure (OR = 5.98) are independent predictors for LOS in preterms.
The study confirms the presence of maternal urinary tract infection, hospitalization days, heart fail-ure, and CRP level as predictors of neonatal sepsis in preterms with differences between EOS and LOS.
新生儿败血症是新生儿重症监护病房的常见疾病之一。在此，我们旨在评估一组患败血症的早产儿与对照组在临床和实验室变量方面的差异。此外，我们的目标是确定早发型败血症（EOS）和晚发型败血症（LOS）的潜在预测因素。
该研究纳入了113例患败血症的早产儿（EOS占63.72%/LOS占36.28%）。实验室检测包括全血细胞计数、CRP、生化检测、血培养。
最重要的单变量新生儿预测因素为胎龄（p < 0.001）、表面活性剂使用（p < 0.001）、机械通气（p < 0.001）、心力衰竭（p < 0.001）、低钙血症病史（p = 0.037）、1分钟Apgar评分低于7分（p = 0.001）、出生体重<1500 g（p = 0.005）、住院天数（p = 0.048）以及体重恢复天数<10天（p < 0.05）。第7天时，白细胞（WBC）和CRP参数仍是败血症的重要单变量预测因素（p = 0.002；每10,000 mm³WBC增加，OR = 2.01，95%CI：(1.30; 3.09)；p = 0.001；OR = 4.27，95%CI：(1.85; 9.88)）。逻辑回归分析显示，母亲泌尿系统感染（OR = 3.05）、心力衰竭（OR = 5.28）、住院天数（OR = 1.09）和CRP（OR = 3.26）是早产儿发生新生儿败血症的重要独立危险因素。EOS的单变量预测因素为胎龄（p = 0.002）、出生体重（p = 0.014）、1分钟Apgar评分（p = 0.012）、母亲泌尿系统感染（p = 0.008）、表面活性剂使用（p < 0.001）、心力衰竭（p < 0.001）以及CRP水平（p < 0.001）。根据多变量模型，表面活性剂使用（OR = 6.73）和CRP水平（OR = 3.51）是早产儿EOS的预测因素。LOS的单变量预测因素为胎龄（p = 0.001）、出生体重（p = 0.048）、1分钟Apgar评分（p = 0.001）、表面活性剂使用（p < 0.001）、低钙血症（p = 0.03）、心力衰竭（p = 0.003）、CRP水平（p < 0.001）、机械通气（p < 0.001）以及住院天数（p < 0.001）。在多变量模型中，住院天数（OR = 1.11）和心力衰竭（OR = 5.98）是早产儿LOS的独立预测因素。
该研究证实母亲泌尿系统感染、住院天数、心力衰竭和CRP水平是早产儿发生新生儿败血症的预测因素，且EOS和LOS之间存在差异。
