بررسی علائم بالینی، فاکتورهای خطر مادری و نوزادی در 285 نوزاد با سپسیس قطعی

نوع مقاله : اصیل پژوهشی

نویسندگان

1 استاد گروه کودکان، دانشکده پزشکی، دانشگاه علوم پزشکی مشهد، مشهد، ایران.

2 دانشجوی کارشناسی پرستاری، دانشکده پرستاری و مامایی، دانشگاه علوم پزشکی آزاد اسلامی، مشهد، ایران.

3 مربی گروه پرستاری، دانشکده پرستاری و مامایی، دانشگاه علوم پزشکی آزاد اسلامی، مشهد، ایران.

چکیده

مقدمه: سپسیس نوزادی یکی از رایج‌ترین علت مرگ‌و‌میر نوزادان به‌شمار می‌آید. مطالعه حاضر با هدف بررسی جامع شیوع علائم بالینی، فاکتورهای خطر مادری و نوزادی سپسیس در ﻧﻮزادان مبتلا به سپسیس قطعی ﺑﺴﺘﺮی شده در ﺑﺨﺶ ﻣﺮاﻗﺒﺖﻫﺎی وﯾﮋه انجام شد.
روشکار: این مطالعه کوهورت گذشته‌نگر در سال 90-1398 بر روی 285 نوزاد بستری شده در بخش نوزادان بیمارستان قائم (عج) انجام شد. نوزادانی که کشت خون مثبت به‌علاوه حداقل یک علامت بالینی عفونت و یک علامت آزمایشگاهی داشتند، به‌عنوان سپسیس قطعی وارد مطالعه شدند. پس از تأیید سپسیس در نوزادان بر اساس نتیجه کشت خون و نتایج آزمایشگاهی، چک‌لیست پژوهشگر ساخته حاوی مشخصات مادری، نوزادی و آزمایشگاهی نوزادان تکمیل شد. تجزیه و تحلیل داده‌ها با استفاده از نرم‌افزار آماری SPSS (نسخه 23) و آزمون‌های تی مسقل و کای اسکوئر انجام شد. میزان p کمتر از 05/0 معنی‌دار در نظر گرفته شد.
یافته‌ها: در این مطالعه 44/35% از موارد به سپسیس زودرس و 64/66% به سپسیس دیررس مبتلا بودند. شایع‌ترین علت خطر جنینی سپسیس زودرس نوزادی، پره‌ترم (86%) و شایع‌ترین عوامل خطر مادری سپسیس زودرس نوزادی، پارگی زودرس کیسه آب (6/19%)، پره‌اکلامپسی (08/15%)، هایپرتانسیون (36/7%)، کوریوآمنیوتیت (6/6%) و دیابت (56/4%) بود. طول مدت بستری در بیمارستان، مدت تهویه مکانیکی و طول مدت اکسیژن‌تراپی از عوامل خطر سپسیس دیررس بودند. شایع‌ترین علائم بالینی و آزمایشگاهی سپسیس شامل دیسترس تنفسی، کاهش فشارخون، افت SPO2، آپنه، زردی، دیستاسیون شکمی، تاکی‌کاردی، تشنج، CRP بالا (77%)، ترمبوسیتوپنی (53%)، لوکوسیتوز (38%)، اختلال انعقادی (36%) و ESR بالا (3/22%) بودند.
نتیجه‌گیری: شایع‌ترین ریسک فاکتور سپسیس زودرس نوزادی، تولد قبل از موعد و پارگی زودرس کیسه آب بود، لذا کنترل و حذف عوامل مستعد کننده نارسی و PROM ممکن است از بروز سپسیس نوزادی بکاهد. شایع‌ترین علامت بالینی، دیسترس تنفسی و شایع‌ترین علامت آزمایشگاهی، CRP مثبت بود.

کلیدواژه‌ها


عنوان مقاله [English]

Clinical symptoms, maternal and neonatal risk factors of 285 neonates with definitive sepsis

نویسندگان [English]

  • Hasan Boskabadi 1
  • Nazgol Behgam 2
  • Fatemeh Bagheri 3
1 Professor, Department of Pediatrics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
2 B.Sc. Student in Nursing, School of Nursing and Midwifery, Islamic Azad University of Medical Science, Mashhad, Iran.
3 3) Instructor, Department of Nursing, School of Nursing and Midwifery, Islamic Azad University of Medical Science, Mashhad, Iran.
چکیده [English]

Introduction: Neonatal sepsis is one of the most common causes of neonatal mortality. This study was performed with aim to evaluate the clinical symptoms, maternal and neonatal risk factors of definitive sepsis in neonates admitted to the neonatal intensive care unit.
Methods: This retrospective cohort study was conducted in 2011-2019 on 285 infants admitted to the NICU of Ghaem Hospital in Mashhad. Neonates with positive blood culture and at least one clinical symptom and laboratory result of sepsis were considered as definitive sepsis and entered the study. After confirming the diagnosis based on the blood culture and laboratory report, the researcher-made checklist containing maternal, neonatal, and laboratory characteristics of the neonates was completed. Data were analyzed by SPSS software (version 23) and independent t-test and Chi-square test. P<0.05 was considered statistically significant.
 Results: In this study, 35.44% of cases were diagnosed as early sepsis and 64.66% as late sepsis. The most common cause of fetal risk of early neonatal sepsis was preterm (86%) and the most common maternal risk factors for early neonatal sepsis were premature rupture of membrane (19.6%), preeclampsia (15.08%), hypertension (7.36%), chorioamnionitis (6.6%), and diabetes mellitus (4.56%). Duration of hospitalization, duration of mechanical ventilation, and duration of oxygen therapy were the risk factors for late sepsis. The most common clinical and laboratory symptoms were respiratory distress, hypotension, SPo2 loss, apnea, jaundice, abdominal distention, tachycardia seizures, high CRP (77%), thrombocytopenia (53%), leukocytosis (38%), coagulopathy (36%), and high ESR (22.3%).
 Conclusion: The most common risk factor for early neonatal sepsis was prematurity before PROM. Therefore, controlling and eliminating the predisposing factors of PROM and prematurity may reduce the incidence of neonatal sepsis. The most common clinical symptom was respiratory distress and the most common laboratory symptom was positive CRP.

کلیدواژه‌ها [English]

  • clinical signs
  • Early Neonatal Sepsis
  • late neonatal sepsis
  • neonate
  • Risk factors
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