MRI Analysis Of Purulent Meningitis In Premature And Full Term Infants

Objective:To compare the head magnetic resonance(MRI)changes of purulent meningitis in premature and full-term neonates.Methods:This retrospective study assessed clinical data in 43 cases of neonatal purulent meningitis with positive blood or cerebrospinal fluid bacterial culture admitted to the neonatal ward of shengjing hospital of China Medical University from January 2012 to November 2019.According to the gestational age,the patients were divided into the premature group and the full-term group.The general situation,head MRI and pathogen characteristics of the two groups were compared.Results:The incidence of premature rupture of fetal membranes in premature group(50%vs 5.88%)was higher than full-term group(c~2=9.011,P<0.05),the rate of cesarean section in premature group(61.54%vs 23.53%)was higher than full-term group(c~2=5.969,P<0.05),and there was no significant difference between the two groups in age of onset(9.8±7.0 d,8.9±5.5 d),diagnosis(13.0±7.1 d,10.2±6.1 d)and examination(16.1±7.9d,13.1±6.5 d)(P>0.05).The top three pathogens were 14 cases of Klebsiella pneumoniae,11 cases of Escherichia coli and 7 cases of Streptococcus agalactiae(GBS).Klebsiella pneumoniae was the most common pathogen in premature infants,and GBS was the most common pathogen in full-term infants.In the first MRI,white matter injury was the most common,accounting for 19/43 cases,the abnormal rate of MRI in premature infants was 65.38%(17/26 cases),the incidence of intracranial hemorrhage was higher than that of full-term infants,the abnormal rate of MRI in full-term infants was 52.94%(9/17 cases),and the incidence of cerebral infarction was higher than that of premature infants.The MRI positive rates of meningitis caused by Klebsiella pneumoniae,E.coli and GBS were 57.14%(8/14 cases),72.73%(8/11cases)and71.43%(5/7 cases)respectively.The main complications of Klebsiella pneumoniae infection were white matter injury and intracranial hemorrhage.Infants infected with E.coli were prone to white matter damage in the early stage and hydrocephalus in the late stage.Infants with GBS were prone to white matter injury and cerebral infarction in the early stage and cerebromalacia in the late stage.Conclusion:The distribution of pathogenic bacteria and head MRI changes between premature infants and full-term infants,and head MRI of purulent meningitis caused by different pathogenic bacteria were different.Klebsiella pneumoniae was the most common pathogen in premature infants,and GBS was the most common pathogen in full-term infants.In early MRI,white matter injury is the most common,intracranial hemorrhage often occurs in premature infants,and cerebral infarction often occurs in full-term infants.Infants infected with E.coli were prone to hydrocephalus in the late stage.Infants with GBS were prone to cerebromalacia in the late stage.Master the distribution of pathogens and the characteristics of head MRI in premature and full-term infants is helpful for the early diagnosis,treatment and prognosis of the disease.