| Objective：Summarize the clinical features of neonatal listeriosisto enrich our neonatal listeriosis clinical data and improve the diagnosis andtreatment strategies. Method： Retrospective analysis the history, clinicalpresentation, examination findings, antibiotic resistance, treatment andprognosis of20cases with neonatal listriosis of our hospital, and perfomingstatistical analysis. Result：The20patients of this group include16pretermcases (very preterm4cases, gestational age＜32w),4term cases,8males(40%)and12females(60%),18cases (90%)for the first parturition,2cases(10%) forthe second parturition,10cases(50%) for the first pregnant. The age of maternalbetween24to30years old have13cases(65%),31to35years old have3cases(15%),36to40years old have3cases(15%),11cases(55%) have a clearhistory of fever,3cases(15%) have an unclean diet history.11cases (55%)birthwith fetal distress,7cases(35%) of amniotic fluid Ⅲ°meconium-stained,6cases(30%) of birth asphyxia, All cases were onset neonatal literiosis within3days after their birth, mainly representing a poor mental reactions, fever, weakbreathing and weak muscle tone, severe cases with septic shock performancesuch as pale skin and poor perfusion. White blood cell (WBC) count was(1.17~67.9)×109/L, neutrophil was(1%~94%), monocyte was(0%~20%);C-reactive protein (CRP) was (1~261)mg/L; Procalcitonin (PCT) was (1.7~＞100)ng/ml; The cerebrospinal fluid (CSF) test of17cases showed:WBC(11~1305)×106/L, monocytes (20%~100%), protein (0.67~4.23)g/L,glucose (0.58~3.06)mmol/L;19cases(20times) of blood cultures are Listeriamonocytogenes,4cases with CSF cultures are positive.8cases of chest X-raypresent respiratory distress syndrome (RDS),5cases present patchy shadow,3 cases present patchy cloud flocculent,6cases don’t had obvious abnormalities.By the severity of clinical, the cases can divide into non-critical, critical andvery critical, which including10cases (50%),8cases (40%) and2cases (10%)separately. Complications include severe pneumonia and/or respiratory distresssyndrome, meningoencephalitis, septic shock, hepatitis, necrotizing enterocolitis,newborn Scleroderma, Disseminated intravascular coagulation, capillary leaksyndrome, environmental disorders, and so on.18kinds of antibioticsusceptibility results: vancomycin, erythromycin, rifampin,trimethoprim-sulfamethoxazole etc. sensitive rates were100%; penicillin,ampicillin and clindamycin sensitive rates were55%,66.7%and23%; oxacillin100%(13/13) resistance.8cases used penicillin,9cases used vancomycin,4cases used erythromycin;8cases(40%) were cured,7cases(35%) improved, fivecases (25%) died, which occupying50%of the critical and very critical cases.Conclusion：The incidence of neonatal listeriosis showed an increasing trend.First pregnancy and parturition, the younger maternal age range24to30yearsold, history of eating contaminated food, and prenatal fever all are risk factorsfor neonatal listeriosis, all these factors sometimes lead to preterm. Obstetriciansshould focus on maternal health education, prevention of eating suspiciouscontaminated food. For preterm labor, fetal distress and other suspicious casespediatrician should fully assesse, particularly pay attention to assess theinvolvement of the lungs, liver, brain and cardiovascular, focusing on warningsignal such as blood, CRP, PCT, but diagnosis still rely on humoral cultured outpathogen. When Suspecting or haven diagonosised listeriosis, we shouldadministration of an effective antibiotic early.This study showed that ListeriaMonocytogenes resistance to penicillin and ampicillin increased, the report inthe literature for the current use of penicillin and ampicillin as a first-linetreatment of listeriosis should be re-evaluated. Our experience suggests thatvancomycin joint meropenem is recommended preferred, even susceptibility results display penicillin is sensitive, still need to pay attention to the dosage andfrequency, it’s better to have a blood circulation drug monitoring. Neonatallisteriosis have a high incidence, when poorly controlled the disease progressedrapidly, meanwhile the mortality is very high. Especially pay attention to thetreatment of critical and very critical cases, need special attention and verycritical of the treatment of critically ill children, while strengthening themanagement of septic shock, severe pneumonia or RDS, capillary leaksyndrome, disorders and other complications, is expected to improve the curerate, and is the key to reducing the morbidity and improve the prognosis. It is amajor problem that to diagnose neonatal listeriosis early, recently studies haveshown that neutrophils play an important role in anti-listeria infection.Neutrophil extracellular traps(NETS) and circulating free DNA(cf-DNA) whichproduced by neutrophils are expected to as an early monitor to diagnoseneonatal listeriosis. |
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