The Analysis Of Poor Prognosis And Prognosis Factors In Neonatal Purulent Meningitis

Objective:To investigate the variety of poor prognosis and the risk factors in neonatal purulent meningitis.To realize the importance of long-term follow-up.Methods:Clinical datas of neonatal purulent meningitis were collected and analyzed retrospectively from November 2010 to November 2014 in neonatal department of Soochow University Affiliated Children’s Hospital.Intrapartum asphyxia,other serious neurological or endocrine system diseases,congenital metabolic diseases,congenital malformations of nervous system, cranial trauma and other diseases which could affect development of nervous system were excluded.There were 54 cases,including 2 death cases.Other 52children’s parents were called to take their children to our or their local hospital accepting a test to evaluate their development quotient(DQ).DQ less than 85 was low and more was normal. And the situation after discharging from hospital was essential to be collected.There were only 29 cases completing the test. They were divided into two groups:poor prognosis,including the cases of DQ less than 85 and death,and general prognosis,including the cases of DQ more than 85. Data was analyzed by using the Statistical Package of Social Science version 20.Statistical analysis of test level α=0.05.We used the Fisher’s exact to compare categorical variables,and used the t test or rank sum test to compare numberical variables of the prognostic factors among these two different groups.Result:1.There were 29 cases having finished the test. 5 cases were mental retardation temporarily and 2 cases with motor deficit.In addition,2 cases were dead after giving up therapy.There was no hearing loss, vision loss or secondary epilepsy.7 cases(22.58%) were brought into poor prognosis group,and 24 cases(77.42%) were normal prognosis group.2.In this study,including the 2 death cases,there were 31 cases.Convulsion was seen in 9 cases(29.03%,P=0.012).Dusphoria was seen in 7 cases(22.58%,P=0.029). Abnormal cranial imaging was seen in 17 cases(54.84%,P=0.009).CSF WBC count>1500×10^6/L was seen in 7 cases(22.58%,P=0.029),and CSF protein concentration>2000mg/L was seen in 14 cases(45.16%,P=0.028). They were significantly different between these two groups.3.Children who had used neurotrophic drugs(17 cases,54.84%) and dexamethasone(10 cases,32.26%) had higher incidence(41.18%,50.00%) of neurological sequelae than who had not used(0%,9.52%).This may be related to severe children had used them,but others had not.Conclusion:1.The poor prognosis in our research were mental retardation temporarily,motor deficit and death.2.The clinical manifestations :convulsion and dysphoria,abnormal cranial imaging,cerebrospinal fluid(CSF) white blood cell(WBC)count >1500×10^6/L and CSF protein concentration >2000mg/L were the risk factors of poor prognosis.3.The functions of neurotrophic drugs and dexamethasone to improving prognosis were not obvious.4.Long-term follow-up was necessary to neonatal purulent meningitis.So the one who had sequelae could be treated appropriately as early as possible.