Risk Factors For Poor Prognosis And Clinical Characteristics Of Neonatal Bacterial Meningitis

ObjectiveTo investigate the risk factors for poor prognosis of neonatal bacterial meningitis,explore the differences in clinical characteristics of bacterial meningitis in preterm infants and term infants,provide basis for diagnosis and treatment of neonatal bacterial meningitis.MethodsA retrospective analysis was performed on the data of 152 neonates with bacterial meningitis in newborn department of our hospital from June 2013 to June 2018.According to the outcomes they were divided into good prognosis group and poor prognosis group,according to the gestational age they were divided into term infants group and preterm infants group.The differences in general characteristics,first manifestations,and laboratory tests were respectively compared between the good prognosis group and the poor prognosis group,also the term infants group and the preterm infants group.Results1.The proportion of extremely low birth weight,duration of treatment and hospitalization costs in the poor prognosis group were higher than the good prognosis group,the difference was statistically significant(P<0.05).2.There was no significant difference in the comparison of first manifestations(fever,poor response,jaundice,apnea/distress,poor feeding/vomiting,irritability,convulsion)between the poor prognosis group and the good prognosis group(P>0.05).3.The cerebrospinal fluid(CSF)white blood cell(WBC)count and protein content of the poor prognosis group was significantly higher than that of the good prognosis group,and the CSF glucose content was significantly lower than that of the good prognosis group(P<0.05).The poor prognosis group had a significantly higher proportion of a peripheral blood WBC count<5 × 109/L or>20 × 109/L,a C-reactive protein level>50 mg/L,a CSF WBC count>500×106/L,a CSF glucose level<1 mmol/L,or a CSF protein level>2 g/L(P<0.05).4.In our study,the culture positive pathogens were Escherichia coli(10 cases),Klebsiella pneumoniae(9 cases),Staphylococcus(6 cases),Streptococcus(5 cases),Listeria(3 cases),Enterococcus faecium(2 cases),Klebsiella ozaenae(1 case),Enterobacteria long-term(l case).The positive rate of blood culture and/or CSF culture and the positive rate of gram-positive bacteria culture in the poor prognosis group was significantly higher than the good prognosis group(P<0.05).The culture positive rate of Staphylococcus and Streptococcus agalactis was significantly higher in the poor prognosis group(P<0.05).The culture positive rates of other bacteria were not significantly different between the two groups(P>0.05).5.The multivariate logistic regression analysis showed that a CSF glucose level of<1 mmol/L and a CSF protein level of>2 g/L were independent risk factors for poor prognosis of neonatal bacterial meningitis.6.Compared with the term infants group,the incidence of fever(33.3%vs 71.6%)was lower in the preterm infants group,the incidence of poor mental response(27.8%vs 8.6%)and apnea/distress(25%vs 0.9%)was higher in the preterm infants group(P<0.05).7.The CSF glucose content of the preterm infants group was significantly lower than that of the term infants group,and the CSF protein level of the preterm infants group was significantly higher than that of the term infants group(P<0.05).Conclusions1.A CSF glucose level of<1 mmol/L and a CSF protein level of>2 g/L are risk factors for poor prognosis of neonatal bacterial meningitis.2.In recent 5 years,the top three pathogens of neonatal bacterial meningitis in our hospital were Escherichia coli,Klebsiella pneumoniae,Staphylococcus.3.There were significantly differences in the clinical manifestations and cerebrospinal fluid tests between the term infants group and the preterm infants group with bacterial meningitis.The clinical manifestations were more insidious,the CSF glucose level was lower,and the CSF protein level was higher in the preterm infants group.