Clinical Analysis Of Neonatal Purulent Meningitis

Objective: The goal of the retrospective cohort study is to investigatethe clinical characteristics of neonatal purulent meningitis （PM）, bycomparing the full term group and the preterm group, so as to provide advicefor the prevention and treatment of this disease.Methods： A total of98cases of neonatal purulent meningitis wereidentified in the neonatal department of Children’s Hospital of ChongqingMedical University between February1,2007and February28,2013.According to gestational age,it was divided into the full term group and thepreterm group. Symptoms and signs, Laboratory tests, pathogen, imagingexaminations, complications and outcome were collected. Results wereanalyzed by Chi-square test and t-test. The level of significance consideredwas p <0.05.Results：Among all neonates with PM,there were some commonfactors as follow: male,within7day of age of onset, winter and spring.Chi-square test results showed that：There were certain differences betweenthe full term group and the preterm group were statistically significant. Forfull term group, fever（χ2=12.529，P <0.001） and convulsions（χ2=5.286， P=0.022） are found higher than the preterm group. For preterm group, muscle tone reduction（χ2=11.113， P=0.001） was foundhigher than the full term group. Among all patients with PM,96(97.96%)had pneumonia and74(75.51%) had septicemia, the number of people whohad other infection disease was little. There were no statistical difference ofcomplications between the two groups（P＞0.05）. Cerebrospinal fluid(CSF)culture and blood culture were performed for all newborns with PM. Only11(11.22%) of98neonates had a positive cerebrospinal fluid culture. However,the full term group was11.94%and the preterm group was9.68%. Amongthe11cases,8cases of the pathogenic bacteria detected in CSF culturewere Gram-negative rods.There was no significant difference in the level ofWBC (blood/CSF) between the term newborns and the preterm newbornswith PM（P＞0.05）. T-test results showed that：The preterm group showeda lower level of glucose in CSF than the full term group, which wasstatistically significant (t=2.498, P=2.498).The imaging of neonatal braininjury was found in different imaging examinations, which was more thansubdural effusion. The morbidity of PM was20.41%(20/98), among which14.93%(10/67) was the full term group,32.26%(10/31) was the pretermgroup.49cases of our study were followed-up by telephone. There were28cases(the full term group:20cases, the preterm group:8cases) had no obviousphysical or neuropsychological development problem. There were8cases(the full term group:5cases, the premature group:3cases) who hadmovement or/and vision disorders. Conclusion: comparing with the full term group, the clinicalmanifestations of the preterm group with PM were atypical. For full termgroup, fever and convulsions are found higher than the preterm group. Forpreterm group, muscle tone reduction was found higher than the full termgroup. The positive rate of the culture was low. The main pathogenicbacteria detected in culture were Gram-negative rods. The preterm groupshowed a lower level of glucose in CSF than the full term group. Neonatalpurulent meningitis can be recovered after a standard treatment, andprognosis of the full term was better than the preterm group. Studies onpreterm neonate with PM should be enhanced. Both group had a highincidence of sequela, so the subsequent treatment is needed.