Clinical Analyzing of Neonatal Purulent Meningitis

doi:10.3877/cma.j.issn.1673-5250.2014.01.003

Objective

To study the clinical manifestations, treatment and hospitalized outcomes of neonatal purulent meningitis.

Methods

This was a prospective observational study with institutional ethics approval of West China Second University Hospital, Sichuan University and written consent from the parents of each participating neonate. From January 2008 to December 2012, a total of 52 neonates with neonatal purulent meningitis in West China Second University Hospital, Sichuan University were recruited. Their clinical manifestations, lab examination results, head image results, and prognoses were analyzed respectively.

Results

The most frequently signs were low response(61.54%,32/ 52) and fever(57.69%, 30/ 52) , the incidence of nerver system abnormal signs such as abnormal muscle tone(51.92%,27/ 52) , seizure(28.85%,15/ 52) , bulging fontanel(19.23%,10/ 52) and positive meningeal irritation sign(3.85%,2/52) was low among 52 neonates with neonatal purulent meningitis．The positive incidence of the first result of lab test including infection markers in blood and cerebrospinal fluid (CSF) was low also．There had significance difference between blood white blood cell (WBC) and C-reacting protein(CRP) (63.50% vs． 38.46%, P<0.05) , and between WBC and protein amount in CSF (67.31% vs． 38.46%, P<0.01) , respectively．The pathogenic bacteria raised from blood and CSF, Gram-negative(G^-) bacteria were more than Gram-positive (G⁺) , the Escherichia coli took the first place (26.92%, 7/ 26) ; All bacteria were conditional pathogenic bacteria, most of these were multiple resistant bacteria (69.23%, 18/ 26) ．Every patient received at least two antibiotics, the 3rd generation cephalosporin were the most popular(82.69%, 43/ 52) , following meropenem (38.46%,20/ 52) , there were 3 cases used vancomycin and cefepime (4th generation cephalosporin) respectively.

Conclusions

To discriminate neonatal purulent meningitis early, we need a constant surveillance for neonatal having high risk factors of meningitis and serial CSF examing. Most pathogens were multiple resistant bacteria. It is hard to be cured, and the prognoses are poor.

Key words: Meningitis, bacterial, Infant, newborn, Anti-bacterial agents

表1 本组52例患儿临床症状及体征比较[n（％）]

Table 1 Comparison of signs and symptoms among 52 neonates with neonatal purulent meningitis[n（%）]

症状体征	发生率	症状体征	发生率
反应差	32(61.54)	肌张力增高	13(25.00)
发热	30(57.69)	前囟张力增高	10(19.23)
原始反射减弱	20(38.46)	腹胀	5 (9.62)
黄疸	19(36.54)	呼吸暂停	3 (5.77)
惊厥	15(28.85)	颈阻呈阳性	2 (3.85)
呼吸频率增快	14(26.92)	便血	1 (1.92)
肌张力降低	14(26.92)

表1 本组52例患儿临床症状及体征比较[n（％）]

Table 1 Comparison of signs and symptoms among 52 neonates with neonatal purulent meningitis[n（%）]

症状体征	发生率	症状体征	发生率
反应差	32(61.54)	肌张力增高	13(25.00)
发热	30(57.69)	前囟张力增高	10(19.23)
原始反射减弱	20(38.46)	腹胀	5 (9.62)
黄疸	19(36.54)	呼吸暂停	3 (5.77)
惊厥	15(28.85)	颈阻呈阳性	2 (3.85)
呼吸频率增快	14(26.92)	便血	1 (1.92)
肌张力降低	14(26.92)

表2 入院时患儿外周血白细胞计数、C-反应蛋白水平与脑脊液中白细胞计数及蛋白含量比较[n（％）]

Table 2 Comparison between white blood cell count and C-reacting protein in blood，white blood cell count and protein in cerebrospinal fluid just be hospitalized[n（%）]

实验室检查	外周血				脑脊液
	WBC计数(×10⁹/L)		CRP(mg/L)		WBC计数(×10⁵/L)		蛋白含量(g/L)
	正常(<10)	异常(≥10)	正常(≤20)	异常(>20)	正常	异常(<5或>20)	正常(≤1.6)	异常(>1.6)
	32(61.54)	20(38.46)	19(36.54)	33(63.46)	27(43.69)	35(67.31)	32(61.54)	20(38.46)
χ²	6.26				11.53
P	0.01^a				<0.01^b

表2 入院时患儿外周血白细胞计数、C-反应蛋白水平与脑脊液中白细胞计数及蛋白含量比较[n（％）]

Table 2 Comparison between white blood cell count and C-reacting protein in blood，white blood cell count and protein in cerebrospinal fluid just be hospitalized[n（%）]

实验室检查	外周血				脑脊液
	WBC计数(×10⁹/L)		CRP(mg/L)		WBC计数(×10⁵/L)		蛋白含量(g/L)
	正常(<10)	异常(≥10)	正常(≤20)	异常(>20)	正常	异常(<5或>20)	正常(≤1.6)	异常(>1.6)
	32(61.54)	20(38.46)	19(36.54)	33(63.46)	27(43.69)	35(67.31)	32(61.54)	20(38.46)
χ²	6.26				11.53
P	0.01^a				<0.01^b

表3 患儿血液与脑脊液细菌培养阳性率比较[n（%）]

Table 3 Comparison of positive bacterial culture rates between blood and cerebrospinal fluid [n（% ）]

结果	血培养(+ )	血培养(－)	合计	χ²	P
CSF培养(+ )	4 (7.69)^a	6(11.54)	10 (19.23)	1.56	0.21^b
CSF培养(－)	12(23.08)	30(57.69)	42 (80.77)
合计	16(30.77)	36(69.23)	52(100.00)

表3 患儿血液与脑脊液细菌培养阳性率比较[n（%）]

Table 3 Comparison of positive bacterial culture rates between blood and cerebrospinal fluid [n（% ）]

结果	血培养(+ )	血培养(－)	合计	χ²	P
CSF培养(+ )	4 (7.69)^a	6(11.54)	10 (19.23)	1.56	0.21^b
CSF培养(－)	12(23.08)	30(57.69)	42 (80.77)
合计	16(30.77)	36(69.23)	52(100.00)

表4 本组26例细菌培养呈阳性患儿的细菌学资料比较

Table 4 Comparison of positive cultured bacteria results

G⁺菌	n	G^-菌	n
沃氏葡萄球菌	2[均为CSF培养(+ )]	大肠埃希菌	7[4例为血培养(+ )；3例为CSF培养(+ )]
单核细胞增生李斯特菌	2[均为血培养(+ )]	脑膜脓毒金黄杆菌	3[1例为血培养(+ )；2例为CSF培养(+ )]
表皮葡萄球菌	2[1例为血培养(+);1例为CSF培养(＋)]	阴沟肠杆菌	3[2例为血培养(+ )；1例为CSF培养(+ )]
金黄色葡萄球菌	1[血培养(+ )]	肺炎克雷伯菌	2[均为血培养(+ )]
屎肠球菌	1[血培养(+ )]	鲁氏不动杆菌	1[血培养(+ )]
粪肠球菌	1[血培养(+ )]
人葡萄球菌	1[血培养(+ )]
合计	10	合计	16

表4 本组26例细菌培养呈阳性患儿的细菌学资料比较

Table 4 Comparison of positive cultured bacteria results

G⁺菌	n	G^-菌	n
沃氏葡萄球菌	2[均为CSF培养(+ )]	大肠埃希菌	7[4例为血培养(+ )；3例为CSF培养(+ )]
单核细胞增生李斯特菌	2[均为血培养(+ )]	脑膜脓毒金黄杆菌	3[1例为血培养(+ )；2例为CSF培养(+ )]
表皮葡萄球菌	2[1例为血培养(+);1例为CSF培养(＋)]	阴沟肠杆菌	3[2例为血培养(+ )；1例为CSF培养(+ )]
金黄色葡萄球菌	1[血培养(+ )]	肺炎克雷伯菌	2[均为血培养(+ )]
屎肠球菌	1[血培养(+ )]	鲁氏不动杆菌	1[血培养(+ )]
粪肠球菌	1[血培养(+ )]
人葡萄球菌	1[血培养(+ )]
合计	10	合计	16

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