SỬ DỤNG CHỈ SỐ LÂM SÀNG, BIOMARKER ĐỂ CHỈ ĐỊNH KHÁNG SINH HỢP LÝ CHO TRẺ SƠ SINH DƯỚI 34 TUẦN TẠI BỆNH VIỆN PHỤ SẢN TRUNG ƯƠNG

Abstract

rkers to appropriately prescribe antibiotics for newborns under 34 weeks of gestation with suspected early neonatal infection who received antibiotics immediately after birth at the Central Obstetrics Hospital. Subjects and methods: Cross-sectional study of 192 newborns under 34 weeks of gestation with suspected early neonatal infection according to NICE 2021 at the neonatal center - Central Obstetrics Hospital. Results: Average gestational age 30.3 weeks, most of them were very premature and extremely premature, weighing < 1500 grams, 56.3% were male and 43.8% were female. Common clinical symptoms immediately after birth were respiratory, digestive and neurological symptoms including rapid breathing (94.3%), chest retraction (94.8%), poor feeding (100%), and decreased muscle tone (50%). Nonspecific clinical features immediately after birth included leukocytosis (2.1%), leukopenia (6.3%), thrombocytopenia (1.6%), CRP ≥ 10 mg/L (1%), acidosis (89.1%). There was 1 positive blood culture (0.5%). The rate of antibiotic discontinuation within 3 days, 5 days and 7 days was 54.2%; 76.6% and 92.9%, respectively. Initial empirical antibiotic therapy was Ampicillin and Aminoglycoside, accounting for 100%. There was a close correlation between clinical progression and CRP results with the ability to discontinue antibiotics early. The group with good clinical condition, negative CRP, and negative blood culture had a very high rate of early antibiotic discontinuation (97.5%). Conclusion: Clinical and paraclinical features immediately after birth are not specific for NKSSS. Combining clinical assessment and CRP and blood culture results helps decide on safe antibiotic withdrawal for infants under 34 weeks with suspected early neonatal sepsis.