Evaluation About High Risk Of Purulent Meningitis In Full Term Infants And Preterm Infants

ObjectiveThe diagnosis of neonatal suppurative meningitis has been a difficult point in clinical work.Moreover,the clinical manifestations of neonatus are not specific,especially the clinical manifestations of premature infants are more atypical.Therefore,to investigate the perinatal factors,clinical manifestation,auxiliary examination and treatment of suppurative meningitis in full term and premature infants,in order to provide ideas and theoretical basis for early diagnosis and treatment of suppurative meningitis in full term infants and premature infants.MethodsWe collected the clinical data of 184 infants who diagnosed as"neonatal purulent meningitis"or"suppurative meningitis"in the department of neonatology at Xi'an Children's Hospital from January 2015 to December 2016.The medical records,the treatment and the information of the follow-up registration were complete.The clinical data of the 184 cases included:(1)Perinatal risk factors.(2)Clinical manifestations on onset and admission.(3)Laboratory tests.(4)The selection of antibiotics.According to Gestational age,these 184 cases were divided into full-term infant group and premature infant group.The count data were expressed as rate(%).?~2 test is used for the comparison of counting data groups(if theoretical frequency is less than 1,Fisher'exact probability method is used).The results were all?=0.05 as the test level,P<0.05as a statistically significant standard.Results1.Risk factors of perinatal period:(1)The common prenatal factors:maternal pregnancy infection(vaginitis and other infections during pregnancy).(2)Factors in birth:amniotic fluid pollution,premature rupture of membranes.(3)Neonatal factors:neonate sepsis,neonatal pneumonia,neonatal diarrhea,skin infection,urinary infection.maternal pregnancy infection,premature rupture of membranes and neonatal septicemia in premature infants were higher,the two groups were statistically significant(P<0.05).2.Statistical results of clinical manifestations and signs of neonatal suppurative meningitis.There were 151 cases of fever(82.1%),128 cases of poor response(69.6%),62 cases of feeding intolerance(33.7%),60 cases of pathological jaundice(32.6%),51cases of weakened primitive reflex(27.7%),41 cases of weakened muscle tension(22.3%),22 cases of irritability(12.0%),19 cases of convulsion(10.3%),18cases of high tension of fontanelle(9.8%),9 cases of cyanosis and groan(4.9%),6cases of apnea(3.3%)and 2 cases of abdominal distention(1.1%),et al.Weakened original reflection,reduced muscle tone,pathological jaundice and apnea were more common in the preterm infants group.There was statistical significance between the two groups(P<0.05).3.Auxiliary examination:(1)White blood cells,the ratio of neutrophilic granulocyte,blood platelet,HsCRP and PCT in peripheral blood were increased.There was no significant difference in blood culture between full term infant group and premature infant group(P>0.05).(2)39 cases were positive for blood culture(33 cases in full term group and 6 cases in premature infant group),there was no significant difference between full term infant group and premature infant group(P>0.05).(3)The incidence of cerebrospinal fluid of protein increased was higher in preterm infants than that in full term infants,and there was significant difference between the two groups(P<0.05).The number of white blood cells in cerebrospinal fluid(CSF)was increased and sugar decreased in the two groups,there was no significant difference between the two groups(P>0.05).The number of white blood cells and the protein of CSF were lower than the diagnostic standard in 7 patients after admission,and 7 cases had reached the diagnostic standard in 48 hours after the examination of cerebrospinal fluid(CSF).The cerebrospinal fluid of two groups were positive in 8 cases(all in full term).(4)Escherichia coli was the mainculture of cerebrospinal fluid and blood.Gram-negative bacteria were generally sensitive to imipenem,meropenem,cefoperazone sulbactam and ceftriaxone,and had high resistance to ampicillin.Gram-positive bacteria were generally sensitive to vancomycin,linazolamine,teicoplanin,and generally resistant to penicillin,oxacillin and erythromycin.(5)The results of cranial magnetic resonance imaging were 35 cases of ventricular widening,33 cases of white matter abnormality,27 cases of intracranial hemorrhage in full term infants and premature infants were found.The ventricle widened and the intracranial hemorrhage occurred earlier.The incidence was higher in the preterm infants group,and there was statistical significance between the two groups(P<0.05).4.The data of empirical anti-infective therapy in full term group and premature group showed the highest choice of cephalosporin was found in the third generation.Cefoperazone-sulbactam were 35 cases(19.0%),ceftriaxonein were 24 cases(13.0%).The longest course of treatment was 40 days,and the shortest was 14 days.Conclusions1.The earlier diagnosis of neonatal purulent meningitis is comprehensive assessment.We propose three levels of diagnostic thinking:(1)Level 1-suspected diagnosis:When premature infants have vaginitis of pregnancy,premature rupture of membranes,amniotic fluid contamination occure in full term infants,once there is an unexplained fever,poor response,feeding intolerance,especially repeated apnea in preterm infants,it is necessary to be alert to the occurrence of neonatal purulent meningitis and cerebrospinal fluid examination as soon as possible.(2)Level 2-clinical diagnosis:Cerebrospinal fluid examination manifested as leukocytosis,which are mainly multinucleated cells,protein significantly increased,sugar decreased,the clinical diagnosis of neonatal purulent meningitis are done.Experience antiinfective therapy should be used as soon as possible.(3)Level 3-etiological diagnosis:The clinical diagnosis case is positive for CSF culture,which is the etiological diagnosis.The therapeutic effect should be re-evaluated and adjusted to sensitive antibiotics according to the drug sensitivity test.2.If the first cerebrospinal fluid examination of premature infants is negative,but still considers the neonatal suppurative meningitis,from the first cerebrospinal fluid examination 48 hours we should review the cerebrospinal fluid again.3.Selection of empirical antibiotics for suppurative meningitis in full-term infants and preterm infants:cefoperazone sulbactam,ceftriaxone,early and sufficient dose.