不同胎龄新生儿院内感染临床特点及危险因素分析

Analysis of clinical characteristics and risk factors of nosocomial infections in infants with different gestational ages

摘要

目的 探讨不同胎龄新生儿院内感染临床特点及危险因素,为临床诊疗提供指导。方法 选取2018年1月至2022年12月于邯郸市中心医院新生儿重症监护室收治的符合纳入排除标准的240例院内感染患儿作为研究对象,根据胎龄分为早期早产儿组(n=193)、晚期早产儿组(n=25)、足月儿组(n=22),采用卡方检验及非参数检验分析三组患儿的一般资料、临床表现、实验室指标、危险因素及治疗情况。结果 晚期早产儿组和足月儿组出生体重更大、住院时间更短(H值分别为78.013、65.523,P<0.05),剖宫产率在晚期早产儿组最高(χ²值为8.423,P<0.05);临床表现整体以反应差、黄疸、消化系统表现(腹胀、呕吐或胃潴留)及呼吸系统表现(呼吸困难)占比较多,三组患儿比较存在统计学差异且以早期早产儿组表现更突出(P<0.05);足月儿组C反应蛋白升高占比多,早期早产儿降钙素原升高占比高(均P<0.05);各组间总体病原菌检出率比较,差异有统计学意义(χ²值为12.939,P<0.05);三组患儿在宫内窘迫、肺表面活性物质(PS)应用、机械通气、氧疗、深静脉置管和肠外营养对比差异均有统计学意义(P<0.05),足月儿组宫内窘迫比例最高(P<0.01),早期早产儿组PS应用率、机械通气、氧疗、深静脉置管及肠外营养时间均居首位(P<0.001)。结论 不同胎龄组新生儿院内感染临床特点及危险因素具有差异性,尽早识别诊断,为不同胎龄新生儿提供个体化诊疗方案,提高新生儿救治水平。

Abstract

Objective To investigate clinical characteristics and risk factors of nosocomial infections in infants with different gestational ages to provide guidance for clinical diagnosis and treatment of nosocomial infections. Methods 240 infants with nosocomial infection who admitted to Neonatal Intensive Care Unit (NICU) of Handan Central Hospital and met inclusion and exclusion criteria from January 2018 to December 2022 were enrolled as study subjects. The infants were stratified into three groups according to gestational age: early preterm infant group (n=193), late preterm infant group (n=25), and full-term infant group (n=22). Chi-square test and nonparametric test were conducted to analyze and compare general information, clinical manifestations, laboratory indexes, risk factors and treatment regimens among the three groups. Results The late preterm infants and the full-term infants with nosocomial infections had significantly higher birth weight and shorter hospitalization length (H=78.013 and 65.523 respectively, both P<0.05). The highest caesarean section rate was seen in the late preterm infants (χ²=8.423, P<0.05). Generally, in clinical manifestations, poor response, jaundice, digestive (abdominal distension, vomiting or gastric retention) and respiratory (dyspnea) manifestations accounted for high proportions in the infants with nosocomial infections, there were differences between the three groups (all P<0.05) and these symptoms and signs were more prominent in the early preterm infant group. The proportion of infants with elevated C-reactive protein (CRP) was higher in the full-term group, while the proportion of infants with elevated procalcitonin (PCT) was higher in the early preterm infants. In overall detection rate of pathogens there was a significant difference among the three groups (χ²=12.939, P<0.05). Intrauterine distress, use of pulmonary surfactant (PS), mechanical ventilation time, oxygen therapy, deep vein catheterization and parenteral nutrition were all independent risk factors for occurrence of hospital acquired infections (HAI), there were significant differences among the three groups (all P<0.05): in the full-term infant group the proportion of intrauterine distress was the highest (P<0.01), while in the early preterm infant group the proportion of PS use was the highest, and times of mechenical ventilation, oxygen therapy, deep vein chatheterization and parenteral nutrition were the longest (all P<0.001). Conclusion There are differences in clinical characteristics and risk factors of HAI among infants with different gestational ages. Early identification and diagnosis of HAI can help to provide personalized diagnosis and treatment plans for the newborns with different gestational ages, so as to improve neonatal rescue and treatment level.

关键词

新生儿 / 胎龄 / 院内感染 / 临床特点 / 危险因素

Key words

neonate / gestational age / nosocomial infection / clinical characteristics / risk factor

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基金资助

河北省卫健委重点科技研究计划(20220521)