| Objective:To review and analyze the clinical data of neonatal purulent meningitis diagnosed in the first affiliated hospital of Kunming Medical University,to explore the clinical characteristics,and outcomes of full-term and premature infants,and to analyze the risk factors of poor prognosis.Method:The data of 36 cases of neonatal purulent meningitis diagnosed in the Department of Neonatology,the first affiliated hospital of Kunming Medical University from January 2016 to February 2021 were analyzed retrospectively.According to the gestational age,they were divided into full-term group and premature group,and according to the short-term outcomes,they were divided into two groups:good prognosis group and poor prognosis group.The general conditions,clinical symptoms and signs,laboratory examinations,imaging examinations and outcomes of the two groups were compared and analyzed to explore the related factors affecting the prognosis of neonatal purulent meningitis.Results:1 Clinical characteristics of 36 cases of neonatal purulent meningitis:There were 36 cases of neonatal purulent meningitis.The occurrence of symptoms in infants both in the term group and the premature group were more common in 3 days after birth.There were 36 cases of neonatal purulent meningitis,of which 15(41.7%)were male and 21(58.3%)were female;13(36.1%)were term infants and 23(63.9%)were preterm infants with 20 cases(87.0%)gestational age of 28-34 weeks,with 3 cases(13.0%)gestational age of 34-37 weeks.The average birth weight was(2049.53±186.02)g.4 cases were less than 1000g(11.1%),13 cases were 1000-1499g(36.1%),6 cases were 1500-2499g(16.7%)and 13 cases were weight≥2500g(36.1%).The average age of onset was(9.86 ± 1.533)days,16 cases with early onset(44.44%)and 20 cases with late onset(55.56%).27 cases(75%)had fever during the course of the disease,and anemia is occurred in 22 cases(61.1%)and coagulation dysfunction in 16 cases(44.4%).Blood culture was positive in 24 cases(66.7%),cerebrospinal fluid culture in 16 cases,and cerebrospinal fluid culture positive rate was 44.4%.A total of 40 strains of pathogenic bacteria were detected,13 cases of Escherichia coli(32.5%)and 9 cases of other pathogenic bacteria(22.5%).10 cases(27.8%)had complications(hydrocephalus in 5 cases(13.9%),subdural effusion in 2 cases(5.6%),cerebral infarction in 2 cases(5.6%)and encephalomalacia in 1 case(2.7%).After treatment,12 cases(33.3%)were cured,18 cases(50.0%)were improved,1 case(2.8%)was transferred to other hospital for surgical treatment,5 cases(13.9%)were discharged automatically.The total rate of the clinical improvement and cure were 83.3%.2 Comparison of clinical characteristics between full-term infant group and premature infant group:Late-onset septicemia was common in term infants and premature infants.There were more cases of IVF and premature rupture of membranes ≥ 18 hours in premature infants group than those in full-term infants group.There was significant difference between the two groups(P<0.05).76.9%of the full-term children had fever as the first symptom.The common clinical manifestations of infants in the term group were fever(84.6%),poor reaction(61.5%),shortness of breath or moaning(61.5%),and hypertonia(61.5%).73.9%of the premature infants had apnea as the first symptom.The common clinical manifestations of infants in the premature group were abdominal distension(78.3%),apnea(73.9%),poor complexion(73.9%),fever(69.9%)and poor reaction(60.9%).The incidences of infants with apnea,abdominal distension and dystonia in the premature group were higher than those in the full-term group,while the incidences of fever,shortness of breath or groaning,irritation,convulsion,hypertonia and thermal peak in the full-term group were significantly higher than those in the premature group(P<0.05).There was significant difference in the incidence of abdominal distension between the premature group and the full-term group(P<0.01).The incidence of anemia,coagulation dysfunction,edema and cholestasis in the premature group was higher than that in the full-term group,and there was significant difference between the two groups(P<0.05).The white blood cell count and the proportion of multinucleated cells in the first cerebrospinal fluid examination(1-2 days after the course of disease)in the full-term group were significantly higher than those in the premature group(P<0.05).In the second cerebrospinal fluid examination(3-4 days),the percentage of cells and the content of chloride in the term group were significantly higher than those in the premature group(P<0.05).Klebsiella pneumoniae and Escherichia coli were the most common pathogens in term group and premature group,but there was no significant difference in the distribution of pathogens between the two groups(P>0.05).The incidence of abnormal imaging findings in the premature group was higher than that in the full-term group,and the incidence of intracranial hemorrhage in the premature group was higher than that in the full-term group,and there was significant difference between the two groups(P<0.05).The incidence of complications and the course of anti-infection in the premature group were higher than those in the full-term group,and there was no significant difference(P>0.05).The hospital duration and costs in the premature group were higher than those in the full-term group,and there was significant difference between the two groups(P<0.05).The cure rate(76.9%)and improvement rate(23.1%)in the full-term group were higher than those in the premature group.One child in the premature group was transferred to other hospital for surgical treatment because of severe hydrocephalus and 5 children were discharged automatically.3 Comparison of clinical characteristics between good prognosis group and poor prognosis group:There were significant differences in gestational age(35.22±5.08 weeks in good prognosis group and 32.37±3.22 weeks in poor prognosis group)and birth weight(2363.48±1225.194g in good prognosis group and 1610.00±784.301g in poor prognosis group),and the incidence of amniotic fluid contamination in poor prognosis group was significantly higher than that in good prognosis group.The incidences of thermal peak,apnea,convulsions and fullness of anterior fontanelle in the poor prognosis group were significantly higher than those in the good prognosis group(P<0.05).The incidence of anemia,coagulation dysfunction,edema and cholestasis in the poor prognosis group was significantly higher than that in the good prognosis group(P<0.05).The white blood cell count,the proportion of multinucleated cells and the content of protein in cerebrospinal fluid in the poor prognosis group were higher than those in the good prognosis group,and the protein content in the three cerebrospinal fluid examinations in the poor prognosis group was higher than that in the good prognosis group.there was statistical significance between the two groups(P<0.05).The common pathogens in good and poor prognosis groups were Klebsiella pneumoniae and Escherichia coli.There was no significant difference in the distribution of pathogens between good and poor prognosis groups(P>0.05).The incidence of abnormal imaging findings in the poor prognosis group was higher than that in the good prognosis group,and the incidences of ventricular dilation and intracranial hemorrhage in the poor prognosis group were significantly higher than those in the good prognosis group(P<0.05).The incidence of hydrocephalus in the poor prognosis group was significantly higher than that in the good prognosis group(P<0.01).Most of the infants had complications in the course of 2-3 weeks,and hydrocephalus was the most common in 5 cases(13.9%).The duration of hospital stay and hospitalization cost in the poor prognosis group were significantly higher than those in the good prognosis group(P<0.05).Conclusion:1.The clinical manifestations of fever,irritation,convulsion and hypertonia in full-term infants with purulent meningitis are more typical compared with premature infants,and the main clinical manifestations in premature infants were apnea,abdominal distension and dystonia.2.The white blood cell count and the proportion of multinucleated cells in cerebrospinal fluid in term infants were higher than those in premature children.The positive rate of cerebrospinal fluid culture was low with 41.7%.Gram-negative bacteria were the main pathogens,and Klebsiella pneumoniae was the most common pathogen.3.Hydrocephalus was the most common complication.Factors such as low gestational age,low birth weight,high thermal peak,apnea,convulsions,fullness of anterior fontanelle,high protein content in cerebrospinal fluid,intracranial hemorrhage often indicated poor prognosis.4.Among the newborns with purulent meningitis,the prognosis of premature infants was worse,the hospital duration was longer,the cost was higher,and the incidence of complications was higher compared with full-term infants. |
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