| Objective:Through the clinical data analysis and follow-up of children with neonatal purulent meningitis(NPM),analyzing the clinical features,prognosis and high risk factors for poor prognosis of NPM in premature and full-term infants,the study provides theoretical basis for early identification,diagnosis and treatment of NPM and rehabilitation intervention as soon as possible.Methods:145 cases admitted between January 1st,2013 and March 31st,2018 in Department of Neonatology,Children's Hospital of Soochow University,meeting the NPM diagnostic criteria were selected as subjects,from which cases with incomplete data and severe congenital diseases were excluded,and all of them completed treatment according to NPM diagnosis and treatment standards.The data for children with NPM on general information,clinical features,laboratory results,skull images,short and long term prognosis were analyzed retrospectively.According to the gestational age,they were divided into premature infant group and full-term infant group.Comparing the clinical features in premature infant and full-term infant with NPM and according to the outcomes at discharge,these two groups were divided into two subgroups respectively:poor prognosis group and good prognosis group of NPM in premature infants,poor prognosis group and good prognosis group of NPM in full-term infants.The risk factors affecting poor prognosis of NPM in premature infants and full-term infants were analyzed and compared.Evaluated the discharged children's follow-up by the Neuropsychological Developmental Examination Table for Children Aged 0-6 Years Old and discussed the long-term prognosis for children with NPM.Results:1.Epidemiological data,clinical features and prognostic data for 145 cases with NPM:In the period between January 1st,2013 to March 31st,2018,26917 neonates were admitted to the Department of Neonatology,Children's Hospital of Soochow University:152 cases were diagnosed as NPM,and the incidence rate was 0.56%.145 cases met the NPM diagnostic criteria and the admission standards,including 87 males(60%)and 58 females(40%).Among the 145 cases,39 cases were premature infants(26.9%)and 106 cases were full-term infants(73.1%).33 cases(22.8%)got infection within one week after born,other 112 cases(77.2%)infected after 7 days;in terms of birth weight,2 cases(1.4%)were less than 1000 g,10 cases(6.9%)were 1000?1449 g,16 cases were 1500?2499 g,117 cases(80.7%)were over 2500 g.50 cases(34.5%)were positive for cerebrospinal fluid(CSF)pathogen culture(among them 21 cases(42.0%)of E.Coli;16 cases(32.0%)of S.agalactiae;13 cases(26.0%)of other pathogens).33 cases(22.8%)had short-term poor prognosis when discharged.Out follow-up for 86 cases were carried,among them 24 cases(16.6%)had long-term poor prognosis and 8 cases died.2.Epidemiological data,clinical features and high risk factors for poor prognosis of NPM in premature infants:There were 39 cases of premature infants with NPM.The average body weight at born was 1953.64±688.66 g;the median on average age of infection onset was 14 days;the median on average days-in-hospital was 35 days.29 cases were in good prognosis and 10 cases were in poor prognosis of NPM in premature infants.Compared between cases with good and poor prognosis,the ration of seizure/convolution for children with poor prognosis was higher(3.4%VS 50%)(?2=0.510,p<0.05);the sugar content in CSF decreased more obviously((1.95±0.64)mmol/L VS(0.99±0.80)mmol/L)(t=3.590,p<0.05);in the counts of white blood cells for peripheral blood,the median for poor prognosis group was 2.84×109/L,lower than good prognosis group of 10.49x109/L(Z=0.189,p<0.05)obviously.Three variables with statistical significance in univariate analysis were included in multivariate Logistic regression analysis.The results showed that the more obvious decrease of sugar content in CSF for NPM course of premature infants suggested that the prognosis of premature infants was prone to poor.3.Epidemiological data,clinical features and high risk factors for poor prognosis of NPM in full-term infants:There were 106 cases of full-term infants,with average body weight at born(3373.49±473.44)g;the median on average age of infection onset was 12 days;the median on average days-in-hospital was 28 days.83 cases were in with good prognosis and 23 cases were in poor prognosis.Compared with good prognosis group,the ratio of seizure/convolution and higher tension of anterior fontanelle for the poor prognosis group increased more obviously((16.86%VS 56.52%)(?2=14.918,p<0.05);(27.7%VS 69.6%)(?2=13.566,p<0.05)).The sugar content in CSF decreased more obviously((2.02±0.93)mmol/L VS(1.20±1.01)mmol/L)(t=3.678,p<0.05);in the contents of proteins(1496.00 VS2201.00)mg/L in CSF(Z=2.916,p<0.05).In the protein content for CSF,the median for poor prognosis group of full-term infants was 2201.00mg/L,higher than good prognosis group of 1496.00mg/L(Z=2.916,P<0.05)obviously.Four variables with statistical significance in univariate analysis were included in multivariate Logistic regression analysis.The results showed that the decrease of the ratio of seizure/convolution,higher tension of anterior fontanelle and sugar content in CSF for NPM course of full-term infants suggested that the prognosis was prone to poor.4.A comparison of the features of NPM between premature and full-term infants:Compared the clinical features between premature and full-term infants with NPM.The thermal spike median for premature infants was 38.0?,obviously lower than that for full-term infants of 39?(Z=5.263,p<0.05).The median for platelet counts in peripheral blood was 122 x109/L,obviously lower than that for full-term infants of(289x109/L)(Z=5.081,p<0.05).The median for count of white blood cells in CSF was 47x106/L,obviously lower than that for full-term infants of 320×106/L(Z=3.273,p<0.05).In the comparision of of positive results ration for NPM blood culture between premature and full-term infants(71.8%VS 49.1%)(?2=5.96,p<0.05).There was no statistic differences between two groups in anorexia,seizure/convulsion,low stimulating response,abnormal muscle tension,higher tension in anterior fontanelle,ages of infection onset,white blood cells in peripheral blood,CRP,PCT,protein and sugar content in CSF(p>0.05).5.Long-term prognosis of NPMOut follow-up for 86 cases were carried.Among them,45 males and 41 females,29 premature infants and 57 full-term infants.In intelligence,0 case for high,12 cases for high average,50 cases for average,13 cases for below average and 3 cases for low.In total,24 cases with poor prognosis(died,below average and low intelligence),62 cases with good prognosis(average and high average intelligence).24 patients with long-term prognosis were reported,including 9 premature infants,and 15 full-term infants.There were 5 cases of hearing impaired patients,3 cases of premature infants,and 2 cases of full-term infants in follow-up.One of the premature infants had a poor long-term prognosis(with intelligence test result of below average).Compared patients with long-term prognosis and short-term prognosis,there were 8 patients with poor prognosis in the short-term and long-term,including 5 full-term infants and 3 premature infants,4 patients with hearing impaired and short-term poor prognosis,including 1 case of full-term infant and 3 cases of premature infants.One of the premature infants had a poor prognosis in the short-term and long-term with hearing impairment.Conclusions:1.The incidence of NPM was not high,and the detection rate of pathogenic bacteria in CSF culture was low.E coli and S.agalactiae were the main pathogenic bacteria in CSF culture;2.The decrease of CSF sugar content in premature infants were risk factors for poor prognosis of NPM in premature infants;while the risk factors for poor prognosis of NPM in full-term infants were seizure/convulsion,higher tension of anterior fontanelle and significant decrease of CSF sugar content;3.The clinical symptoms of NPM in premature infants and full-term infants were not typical,and the thermal spike of NPM in full-term infants was higher than that in premature infants,while the decrease of peripheral blood platelets and the positive rate of blood culture in premature infants were more obvious than that in full-term infants,but the increase of white blood cell count in CSF was not obvious;4.The incidence of intellectual impairment in long-term prognosis of children with NPM was higher. |
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