| Background:A regional city center pediatric and neonatal hospital treatment of critically ill patients in the region will directly affect the level of neonatal mortality and under-five child mortality, and neonatal mortality and mortality of children under five are evaluated one of the most important indicator of the level of health care areas; neonatal purulent meningitis is the cause of the newborn died a very important and common cause; raise the level of neonatal purulent meningitis treatment can effectively reduce neonatal mortality.Objective: To summarize and analyze the clinical characteristics of neonatal purulent meningitis, diagnosis, treatment and outcome, and provide guidance for clinical diagnosis and treatment.Methods:The topics are analyzed retrospectively. Collected the clinical data of160children of purulent meningitis admitted into the hospital from October2009to October2010, whose gender, age, disease duration, clinical features, laboratory tests, treatment, outcomes, and complications were retrospectively analyzed, and neonates purulent meningitis infections. All newborn infants should be in the hospital two days after a routine operation in accordance with the cerebrospinal fluid is collected and sent to a laboratory to check the production of specimens. Other hospitals in the region to collect the same time period neonatal clinical data purulent meningitis morbidity, mortality, automatic discharge rates, and compares with the central hospital.Results:(1) General information: The group of120cases of purulent meningitis in newborns, male74cases (61.67%), female46cases (38.33%), male to female ratio:1.61:1. Age of two days to7days,26patients (21.67%), age of7days to14days,35cases (29.17%), age14days to21days in38cases (31.66%), age21days to28days in21patients (17.5%), with an average age of14.8days. Course of seven days or less are87cases (72.5%), duration of more than7days,33patients (27.5%), mean disease duration was3.2days.(2) Clinical manifestations: Fever101cases (84.17%), convulsions104cases (86.67%), poor response82cases(68.33%), refusing milk64cases(53.33%), irritability47cases (39.17%), vomiting41cases (34.17%), the temperature did not rise11cases (9.17%), anterior fontanelle tension in52cases (43.33%), increased muscle tone79cases (65.83%), decreased muscle tone22cases (18.33%),42cases of jaundice (35%), primitive reflexes63cases (52.5%), pallid50cases (41.67%), neck stiffness32cases (26.67%), respiratory abnormalities51cases (42.5%)(3) Cerebrospinal fluid routine biochemical tests:WBC greater than500×106/L in23cases (19.13%), multiple nucleated cells>60%with55cases (45.83%), glucose2.0mmol/L or less in19patients (15.83%), protein greater than1g/L in37patients (30.83%). Chloride concentration is between88.4mmol/L and146.7mmol/L, the average concentration of116.8mmol/L.(4) The group of children with purulent meningitis and third generation cephalosporins with penicillin therapy: Ceftizoxime64cases (53.33%), ceftriaxone20cases (16.67%), ceftazidime20cases (16.67%), in which switching to vancomycin neomycin and third generation cephalosporins in8cases (6.67%), chloramphenicol and third generation cephalosporins5cases (4.17%), and another three cases (2.5%) applied to meropenem, which were mostly related to vancomycin, chloramphenicol, and joint use of third generation cephalosporins.(5) The group of neonatal purulent meningitis cured82cases (68.33%); improvement in31cases (25.83%), including3cases (9.68%) there is intelligence, movement disorders sequelae; automatically discharged five cases (4.17%) and2deaths (1.67%) (6) The group of children with a total of113cases of complications, raw rate of94.17%. Omphalitis20cases of which (16.67%), impetigo18cases (15%), sepsis35cases (29.17%), intracranial hemorrhage in5cases (4.17%), HIE5cases (4.17%), respiratory failure7cases (5.83%), scleroderma four cases (3.33%), gastrointestinal bleeding7cases(5.83%), pneumonia in4cases(3.33%), hydrocephalus3cases (2.5%), ependymitis3cases (2.5%), toxic intestinal paralysis one case (0.83%), brain swelling one case (0.83%)(7) Neonatal purulent meningitis two logistic regression analysis showed that sepsis, meconium, premature rupture of membranes, impetigo, Omphalitis other children with purulent meningitis affecting the major risk factors.(8) Regional center hospital morbidity, mortality, and automatic discharge rates were94.17%,1.67%and4.17%, while the average regional hospital morbidity, mortality, and automatic discharge rates were93.84%±2.35%,4.15%±0.88%,8.32%±1.16%.Conclusion:(1) Acute onset neonatal purulent meningitis, and the incidence of males than females.(2) Neonatal onset in purulent meningitis and septicemia similar clinical manifestations, the lack of specific symptoms and signs of central nervous system and is often found outside the central nervous system symptoms and characteristics, easy and respiratory systems, digestive diseases such confused.(3) Most of the children with WBC and neutrophils increased significantly; cerebrospinal fluid examination was diagnosed with purulent meningitis diseases is an important basis, but not many typical symptoms of cerebrospinal fluid; neonatal pathogen is mainly the large intestine coli and Staphylococcus epidermidis bacteria and opportunistic pathogens of infection than non-opportunistic pathogens.(4) The majority of children to the third generation cephalosporin-sensitive, can serve as the regional empirical treatment of purulent meningitis, a few children with drug resistance.(5) Neonatal purulent meningitis early diagnosis and early treatment, and select the appropriate antibiotic use, can effectively mortality, lower rates of complications.(6) The group of neonatal complications of purulent meningitis mainly Omphalitis three main types of impetigo and sepsis. Therefore Omphalitis, impetigo and neonatal sepsis should be considered a common cause of purulent meningitis.(7) With sepsis, meconium, premature rupture of membranes, impetigo, Omphalitis other children with purulent meningitis affecting the major risk factors.(8) The Regional Center Hospital neonatal purulent meningitis medical standards than other hospitals in the region. |
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