The Clinical Characteristics Analysis Of Neonatal Purulent Meningitis

Objective:The clinical characteristics of neonatal purulent meningitis（NPM）were analyzed to provide a certain reference for clinical diagnosis and treatment.Methods:A total of 91 children with confirmed neonatal purulent meningitis from September in2019 to September in 2021 were retrospectively analyzed for general information,clinical manifestations,signs and laboratory tests and other clinical data,and were divided into general and refractory groups according to the criteria for determining refractory purulent meningitis（RPM）.Results:1.In this study,there were 91 cases of NPM that met the inclusion criteria,mainly with late onset,and the onset season was mainly in summer and autumn,and the perinatal abnormalities were mainly abnormal amniotic fluid and premature rupture of membranes.The clinical manifestations and signs were mainly fever,abnormal muscle tone and abnormal primitive reflexes.The pathogenic culture rate was 11%,and the main pathogens were Streptococcus lactis and Escherichia coli.In most cases,peripheral blood leukocytes,platelets,C-reactive protein,cerebrospinal fluid protein content and glucose content were within the normal range,and the number of normal and abnormal calcitonin cases accounted for about half of the cases each.The number of abnormal brain MRI cases was 36,which mainly showed intracranial and extracerebral gap widening,intraventricular hemorrhage,abnormal cortical signal,ventricular enlargement,subdural fluid and hydrocephalus;the number of abnormal aEEG cases was 34,which mainly showed delayed maturation and abnormal discharge.2.The data of this study were divided into general and refractory groups according to whether they met the diagnostic criteria for RPM,with 63 cases in the general group and 28 cases in the refractory group.In terms of general data,statistically significant differences were found between the two groups in terms of mode of delivery（P < 0.05）,while no statistically significant differences were found in terms of sex,type of onset,age at admission,age at onset,season of onset,birth weight and gestational age（P >0.05）.3.In terms of pathogenesis,the positive pathogenic culture rate was 3.2% in the general group and 28.6% in the refractory group,and the comparison between the two groups revealed that the positive pathogenic culture rate in the refractory group was higher than that in the general group,and the difference between the two groups was statistically significant（P < 0.05）.4.In terms of clinical manifestations,there was no statistically significant difference in the comparison of manifestations such as fever,convulsions,cyanosis,oligophrenia,and skin yellowing in both groups（P > 0.05）.In terms of signs,the refractory group had a higher probability of cranial hypertension manifestations than the general group（P <0.05）,and the difference was statistically significant,while the differences in abnormal muscle tone and abnormal primitive reflexes were not statistically significant（P > 0.05）.5.In terms of inflammatory indexes,there was no statistically significant difference between the two groups in terms of peripheral blood infection indexes including leukocytes,platelets,C-reactive protein and calcitonin（P > 0.05）.In contrast,in the comparison of cerebrospinal fluid routine and biochemical indexes,it was found that the differences were statistically significant（P < 0.05）in the refractory group in terms of higher CSF leukocyte count,higher protein content,lower sugar content and lower chloride content.6.In terms of laboratory examination,the abnormal rate of cranial MRI was 30.1% in the general group and 60.7% in the refractory group,and the abnormal rate of cranial MRI was higher in the refractory group than in the general group（P < 0.05）,and the difference was statistically significant.In contrast,the aEEG abnormality rate was33.3% in the general group and 46.4% in the refractory group,and the difference in the aEEG abnormality rate between the two groups was not statistically significant（P >0.05）.7.Logistic regression analysis of the relationship between aEEG and MRI and neonatal RPM showed that MRI abnormalities could be an independent risk factor for neonatal RPM and had some predictive value for RPM（P < 0.05）,whereas aEEG was a non-independent risk factor for neonatal RPM（P > 0.05）and lacked predictive value for RPM.8.The sensitivity and specificity of aEEG for the diagnosis of neonatal RPM were46.4% and 66.7%,respectively,and the area under the curve was 0.565;the sensitivity and specificity of MRI for the diagnosis of neonatal RPM were 60.7% and 69.8%,respectively,and the area under the curve was 0.653;the sensitivity and specificity of the combination of the two tests for the diagnosis of neonatal RPM were 60.7% and69.8%,respectively,and the area under the curve was 0.698.The sensitivity and specificity of the two examinations combined for the diagnosis of neonatal RPM were60.7% and 69.8%,respectively,and the area under the curve was 0.698.Conclusion:1.The CSF routine and biochemistry in the refractory group had higher white blood cell count and protein content and lower sugar content than the normal group.The overall positive pathogenic culture rate of NPM was low,but the positive pathogenic culture rate of the refractory group was significantly higher than that of the general group,and was mainly composed of lactococcus-free streptococci and Escherichia coli.2.aEEG was not significantly different in the NPM grouping comparison.The sensitivity and specificity of aEEG in assessing the severity of NPM were 46.4% and66.7%.Brain MRI has a much higher rate of abnormalities in RPM,and its sensitivity and specificity in assessing the severity of NPM is relatively higher.The combination of aEEG and Brain MRI has clinical significance in the assessment of the severity of NPM.