Preliminary Study On Factors Of Hierarchical Diagnosis And Treatment In Purulent Meningitis And Meningoencephalitis In Neonates

ObjectiveTo investigate the high risk factors, clinical manifestations and auxiliary examination of neonatal purulent meningoencephalitis, and, and compare the difference between the neonatal purulent meningoencephalitis and neonatal purulent meningitis, and summarize the factors of hierarchical diagnosis and treatment in neonatal purulent meningitis and meningoencephalitis, for providing the basis for accurate diagnosis and treatment. Methods285 cases of purulent meningitis in full-term and nearly full-term newborns, were retrospectivly diagnosed from our department from October 2013 to June 2015. According to the results of clinical symptoms and auxiliary examination, they were divided into meningitis group and meningoencephalitis group. Temperature instability, abnormal reaction, the intake of milk, low cry, color to gray, gaze, convulsions were common features, Physical examination was indicated that increased intracranial pressure, meningeal irritation positive sign, WBC counts more than 20×106/L in cerebrospinal fluid, mainly for multinucleated cells, increased protein content, decreased sugar content, bacteria by cerebrospinal fluid smear or culture.Brain damage were diagnosed by severe disturbance of consciousness by lethargy or coma, bulging fontanel, neck stiffness, seizures, severe cyanosis requiring mechanical ventilation, and CT/MRI, abnormal aEEG were indicated that brain parenchyma were attacked by suppurative inflammatory, and pathological changes were not confined to the meningeal lesions. Clinical data, including perinatal risk factors, clinical symptoms and signs, laboratory examination, brain CT/MRI and aEEG were collected in two groups; and the data were analysed by the statistical analysis. The significant differences between the two groups were analysed by single factor analysis, and then the correlation between abnormal aEEG, SWC and prognosis of children were analysed by Logistic multivariate regression analysis. Results1. There were 4220 cases were recorded in NICU during the study period, and 285 cases were diagnosed as neonatal purulent meningitis, accounting for 6.75% of the hospitalized children, included 206 cases of purulent meningitis group, 79 cases meningoencephalitis;and 177 cases were male, 108 cases were female.The average weight was(3380 ± 595) g;the average day in patient 9.7 days e; and early onset 91 cases, late onset 194 case.The most common complication were sepsis, pneumonia, and omphalitis.There were no significant differences of general basic massage between the two groups.2. The seizure, intracranial pressure, severe disturbance of consciousness, mechanical ventilation, milk refusal, vomiting, stiff neck, brain imaging abnormalities, concurrent subdural effusion and hydrocephalus, hearing impairment, the duration of hospitalization in meningoencephalitis group were significantly different from thoses in meningitis group,which was more seriously than tahoses in purulent meningitis group(P All < 0.05).3. There were significant differences of leukocyte < 4 or > 10×109/L in peripheral blood, CRP in meningoencephalitis group and meningitis group(P all < 0.05).4. There were significant differences of, leukocyte over 500×106/L, protein ?3000mg/L, glycated protein < 1.1mmol/L in encephalitis group and meningitis group(P < 0.05).5.By the single factor and Logistic regression analysis analysis, the results in the encephalitis group and meningitis group were found that milk refusal, vomiting, convulsions, consciousness disorder, increased intracranial pressure, neck stiffness, mechanical ventilation, blood CRP, white blood cells less than 4 or more than 10×109/L, white blood cells over 500×106/L in cerebrospinal fluid, protein ?3000mg/L, glycated protein less than 1.1mmol/L, brain MRI/CT abnormalities and severe abnormalities of aEEG were independent risk factors of poor prognosis of purulent meningitis(P < 0.05).6. There was significant difference of severe abnormal of aEEG in two groups, and the severe abnormal rate of aEEG in children with encephalitis meningitis was significantly higher than that of encephalitis group, but its sensitivity was not high, and the specificity was 98.5%, positive predictive value were 86.4%,and negative predictive value 77.2%.There were significant difference in the normal and abnormal aEEG in two groups. The abnormal rate of aEEG in was significantly higher than that of meningitis group. There were significant difference light and heavy abnormal aEEG in two groups. The heavy abnormal aEEG in children with sencephalitis meningitis was significantly higher than that in encephalitis group( P < 0.01).7.The poor prognosis rate and the mortality rate in meningoencephalitis were significantly higher than that of meningitis group(?2= 64.037,38.47, P <0.01),; Spearman rank correlation analysis showed that coefficient of meningitis, meningoencephalitis and clinical prognosis was 0.447( P < 0.01).8. Spearman rank correlation analysis showed that the correlation coefficient of aEEG level, SWC and clinical prognosis were r=0.784, 0.583(all P< 0.001). Conclusions1. Neonatal vomiting, milk refusal, convulsions, consciousness disorder, increased intracranial pressure, neck stiffness, mechanical ventilation, blood CRP, white blood cells less than 4 or more than 10×109/L, leukocyte over 500×106/L in cerebrospinal fluid,protein?3000mg/L, glycated protein less than 1.1mmol/L, abnormal brain MRI/CT and severe abnormal aEEG are the independent risk factors of poor prognosis of purulent meningitis,which can be used as a tool of hierarchical and accurate diagnosis and treatment of neonatal purulent meningitis and meningoencephalitis,,which is to improve the prognosis of them. There are significant differences in the mortality and the poor prognosis between the meningitis group and the meningitis group, and are higher in the meningitis group,and predictive values.2. There were significant differences in the abnormal rate and the abnormal ormal degree of aEEG in patients with meningoencephalitis and meningitis. And the abnormal rate of aEEG in patients with meningoencephalitis was higher than that in the meningitis group, and the severe abnormality rate was higher in meningoencephalitis group, and the prognosis of aEEG is worse. aEEG can be used for monitoring brain function in neonatal purulent meningitis,and is helpful for its early diagnosis, also provide a basis for the hierarchical diagnosis and treatment.