早产儿生后感染所致严重脑损伤

Severe Premature Brain Damage Associated with Postnatal Infection

目的探讨早产儿严重感染后出现脑实质广泛软化的临床特点及影像学特征。方法对我院2例早产男婴严重感染后发生脑实质广泛软化的临床资料进行回顾性分析。结果 2例均在生后3周左右发病,表现为反应差、呼吸暂停、超敏C反应蛋白增高、严重肺炎、痰培养多重耐药细菌生长、脑脊液轻微改变等,予呼吸机和抗菌素治疗后病情稳定,临床症状逐渐好转,但影像学检查显示患儿出现广泛脑软化。其母在怀孕期间均无感染迹象及胎膜早破病史,提示患儿脑软化与产后感染有关,而非产前感染所致。结论本研究提示临床不仅需研究产前感染与新生儿脑软化的相互关系,还应增加对早产儿产后感染也可诱发脑软化的认识,常规行头颅超声检查,以早期诊断并进行有效的治疗。

Objective This paper discusses the clinical features and neuroimaging characteristics of severe brain damage in premature infants associated with postnatal infection.Methods We retrospectively analyzed the clinical data of the extensive encephalomalacia secondary to postnatal infection in two preterm infants.Results The two premature boys experienced serious postnatal infection about 3 weeks after birth characterized by lethargic,apnea,increased CRP,serious bilateral pneumonia,positive sputum culture with multidrug-resistant bacteria and mild CSF change.Both of them required ventilation and antibiotic therapy.Finally they survived but a very extensive encephalomalacia was documented by a serial head ultrasound and MRI or CT scan after 3 to 4 weeks of the postnatal infection.As their mothers had no prolonged rupture of membrane and no other risk factor for antenatal infection,postnatal infection was suggested to have some association with encephalomalacia.Conclusion It prompts us to do more investigation regarding possible correlation of encephalomalacia not only with antenatal infection but also its association with postnatal infection.In order to facilitate early diagnosis and effective treatment,cranial ultrasound scanning should be routinely conducted in NICU.