|
|
|
| Analysis of clinical characteristics and high risk factors of neonatal refractory purulent meningitis #br# |
| HE Shumei ZHAO Xiaofen HE Canlin ZHU Shuangyan XIONG Fei FAN Mao MA Lisha LI Yangfang▲ |
| Department of Neonatology, Kunming Children’s Hospital, Yunnan Province, Kunming 650228, China |
|
|
|
Abstract Objective To analyze the clinical characteristics and risk factors of neonatal refractory purulent meningitis. Methods The clinical data of 141 children with purulent meningitis who were admitted to the Department of Neonatology, Kunming Children’s Hospital from January to December 2017 were retrospectively analyzed. According to the bacterial culture results, they were divided into common group (99 cases) and refractory group (42 cases). General data, clinical manifestations, and laboratory test results of two groups were compared. The risk factors of refractory purulent meningitis in neonates were analyzed by logistic regression. Results There were no significant differences in the proportion of male infants, premature infant, birth weight < 2 500 g, amniotic fluid contamination, early-onset meningitis, and anti-infective treatment before admission between two groups (P > 0.05). There was no significant difference in the proportion of fever, convulsion, respiratory symptoms, and digestive tract symptoms between two groups (P > 0.05). The proportion of elevated blood plasma procalcitonin (PCT), positive bacteria culture was higher in refractory group than those in normal group, the white blood cell count and protein content of cerebrospinal fluid (CSF) were higher than those in normal group, and the glucose content of CSF was lower than that in normal group (P < 0.05); there was no significant difference in the proportion of abnormal peripheral blood white blood cell count and elevated blood C-reactive protein between two groups (P > 0.05). There was no significant difference in the distribution of pathogenic bacteria between two groups (P > 0.05). The total incidence of neurological symptoms between two groups was statistically significant (P < 0.05). The fever-reducing time and hospitalization time in refractory group were longer than those in normal group (P < 0.05); there was no significant difference in clinical outcome between two groups (P > 0.05). High CSF protein content, combined with neurological symptoms were independent risk factors for refractory neonatal purulent meningitis (OR > 1, P < 0.05), and high CSF glucose content was a protective factor for refractory neonatal purulent meningitis (OR < 1, P < 0.05). Conclusion The clinical manifestations of neonatal refractory purulent meningitis are not typical. The blood and CSF infection markers of the children are significantly abnormal, and neurological symptoms are prominent. Therefore, it is difficult to treat such children. High blood PCT and CSF protein content, and combined with neurological symptoms are independent risk factors for neonatal refractory purulent meningitis, and high CSF glucose content is a protective factor.
|
|
|
|
|
|
[1] 新生儿细菌性脑膜炎多中心研究协作组.华南部分地区新生儿细菌性脑膜炎多中心流行病学研究[J].中华儿科杂志，2018，56（6）：421-428.
[2] Zhang Y，Sun X，Wu J，et al. Value of MRI enhanced FLAIR sequence examination combined with CSF TNF-α detection in the early diagnosis of neonatal purulent meningitis [J]. Exp Ther Med，2019，17（4）：3124-3128.
[3] 颜慧恒，李晖，王艳丽，等.不同情况新生儿细菌性脑膜炎的住院情况及近期预后分析[J].广东医学，2018，39（24）：3635-3639.
[4] 李国庆.利福霉素注射液联合头孢噻肟钠注射剂治疗化脓性脑膜炎的临床研究[J].中国临床药理学杂志，2018， 34（23）：2683-2685，2689.
[5] 邵肖梅，叶鸿瑁，丘小汕.实用新生儿学[M].4版.北京：人民卫生出版社，2011：349-351.
[6] 赵莹莹，刘佳佳，张家伟，等.儿童不同病原菌所致化脓性脑膜炎的影像学特征[J].中国医学计算机成像杂志，2019，25（2）：106-110.
[7] Otake S，Okada Y，Forsythe SJ，et al. Meningitis and brain abscess formation caused by Cronobacter malonaticus sequence type 440 in a full-term neonate [J]. J Infect Chemother，2021，27（11）：1648-1652.
[8] 方瑞，都鹏飞.血清高敏C-反应蛋白联合降钙素原对足月新生儿败血症并发化脓性脑膜炎的预测价值[J].重庆医学，2019，48（23）：4020-4023.
[9] Huo L，Fan Y，Jiang C，et al. Clinical Features of and Risk Factors for Hydrocephalus in Childhood Bacterial Meningitis [J]. J Child Neurol，2019，34（1）：11-16.
[10] Yal?觭inkaya R，Tanir G，Kaman A，et al. Pediatric subdural empyema as a complication of meningitis：could CSF protein/CSF glucose ratio be used to screen for subdural empyema [J]. Eur J Pediatr，2021，180（2）：415-423.
[11] 郑孟秋，曹传顶，丁颖，等.81例新生儿化脓性脑膜炎临床分析[J].中国感染控制杂志，2020，19（5）：440-446.
[12] 李振光，刘刚.化脓性脑膜炎患儿血液及脑脊液中CD64、PCT水平变化[J].山东医药，2014，54（7）：76-77.
[13] 张林妹，周水珍.儿童中枢神经系统感染治疗疗程与腰椎穿刺检查系列建议之二——细菌性脑膜炎治疗疗程与腰椎穿刺检查建议[J].中国实用儿科杂志，2020， 35（1）：4-6.
[14] 黄彩芝，张洁，莫丽亚.脑脊液肝素结合蛋白检测在小儿化脓性脑膜炎中的应用价值[J].中华检验医学杂志，2019，42（11）：955-961.
[15] 华雪莹，蔡方成，赵智，等.38例新生儿化脓性脑膜炎脑脊液检测结果的病程相关性特征[J].重庆医科大学学报，2018，43（7）：953-956.
[16] 王海如，秦梓健，王斌，等.新生儿化脓性脑膜炎并发脑白质损伤危险因素分析[J].临床儿科杂志，2020，38（2）：104-109.
[17] 杜开先，霍爱香，贾天明，等.儿童难治性化脓性脑膜炎的影响因素研究[J].中国全科医学，2018，21（7）：822-826.
[18] Oganesyan AN，Voropaeva EA，Mel’nikova AA，et al. Efficacy of laboratory methods of diagnostic of purulent bacterial meningitis [J]. Klin Lab Diagn，2019，64（2）：117-121.
[19] Chen B，Zhai Q，Ooi K，et al. Risk Factors for Hydrocephalus in Neonatal Purulent Meningitis：A Single-Center Retrospective Analysis [J]. J Child Neurol，2021， 36（6）：491-497.
[20] 潘海涛.地塞米松辅助抗感染治疗对小儿难治性化脓性脑膜炎的疗效分析[J].中华医院感染学杂志，2018，28（14）：2189-2192.
[21] 李静，杨赞章，张娜，等.化脓性脑膜炎患儿血清、脑脊液促炎因子水平变化及其与病情、血脑屏障破坏程度的关系[J].山东医药，2020，60（14）：71-73.
[22] 陈亿仙，石永言，富建华，等.早产儿和足月儿化脓性脑膜炎磁共振成像的对比分析[J].中华实用儿科临床杂志，2021，36（14）：1068-1073.
[23] 郜英子，程华，吕艳秋，等.各向同性容积扫描增强技术对儿童化脓性脑膜炎的诊断价值[J].中华放射学杂志，2019（7）：599-602.
[24] Demaerel V，Vermeulen F，Desmet L，et al. A 2-Year-Old Boy With an Unusual Bacterial Meningitis and Multiple Brain Abscesses [J]. J Pediatric Infect Dis Soc，2021，10（2）：207-209.
[25] 王贤柱，李玖军.婴幼儿化脓性脑膜炎合并硬膜下积液的危险因素分析[J].中国实用儿科杂志，2019，34（5）：410-413. |
|
|
|
