新生儿暴发性心肌炎11例临床特点分析

Clinical features of 11 newborn infants with fulminant myocarditis

目的 探讨新生儿暴发性心肌炎临床特点、诊疗及预后.方法 选取本院新生儿重症监护病房2016年1～8月收治的新生儿暴发性心肌炎患儿临床资料进行回顾性分析.结果 共纳入暴发性心肌炎患儿11例,其中男6例,女5例;胎龄（37.7±1.6）周,入院体重（3 382 ±675）g;早产儿5例,足月儿6例;夏季发病9例,冬春季发病2例;生后3～5d起病8例,2～3周起病3例;主要表现为发热、食欲减退、气促、精神反应差.患儿均伴不同程度心功能不全,合并心源性休克10例,严重心律失常伴多脏器功能损伤7例,病毒性脑膜炎7例.10例患儿脑钠肽、肌钙蛋白Ⅰ显著升高,且肌钙蛋白Ⅰ超过20 μg/L患儿均预后不良.予以限制液量、应用大剂量肾上腺皮质激素、输注丙种球蛋白治疗,同时纠正休克、改善心功能、抗心律失常等综合治疗,合并呼吸困难患儿给予机械通气,治愈7例,死亡4例.存活患儿中6例随访至6～ 12个月,其中4例出院后1～3个月复查超声心动图正常,2例超声心动图持续异常,最终诊断扩张型心肌病.结论 新生儿暴发性心肌炎临床表现缺乏特异性,早期诊断较困难,容易误诊、漏诊,病死率高,及时诊断、采取有效治疗措施可提高生存率.

Objective To study the clinical features,diagnosis,treatment and prognosis of neonatal fulminant myocarditis.Method From January 2016 to August 2016,clinical data of neonates with fulminant myocarditis admitted to the neonatal intense care unit （NICU） were retrospectively collected and analyzed.Result A total of 11 neonates were enrolled,including 6 males and 5 females,and 5 preterms and 6 full term infants.The average gestation age was （37.7 ± 1.6） weeks and their weight on hospital admission was （3 382 ± 675） g.Among the infants,9 got ill in summer and 2 in spring and winter.The onset of illness was within 3 ～ 5 d after birth in 8 cases and 2 ～ 3 weeks in the other 3 cases.The main clinical presentations included fever,anorexia,shortness of breath and lethargy.Various degrees of cardiac dysfunction appeared in all 11 cases,including cardiogenic shock in 10 cases,severe arrhythmias with multiple organ dysfunction in 7 cases,and viral meningitis in 7 cases.10 infants had significantly elevated brain natriuretic peptide （BNP） and troponin Ⅰ,and those with troponin Ⅰ above 20 μg/L had poor prognosis.A comprehensive treatment of limiting liquid volume,high-dose adrenocortical steroids,and IVIG were carried out.Meanwhile,therapy to prevent shock,improve cardiac function,reverse arrhythmia,and mechanical ventilation were used in children with dyspnea.7 cases were cured and 6 patients were followedup for 6 to 12 months.Among the 6 followed-up patients,within 1 ～3 months after discharge,4 cases had normal echocardiogram,and persistently abnormal echocardiogram were found in the other 2 cases and eventually confirmed as dilated cardiomyopathy.4 patients were dead.Conclusion The clinical manifestations of neonatal fulminant myocarditis are unspecific.It＇s difficult to recognize the early symptoms,missed and delayed diagnosis are common,resulting in high mortality rate.Timely diagnosis and effective treatment can improve the survival rate.