无乳链球菌相关新生儿化脓性脑膜炎15例临床分析

Clinical and prognostic analysis of purulent meningitis associated with Goup B streptococcus in 15 neonates

目的探讨B族链球菌相关的新生儿化脓性脑膜炎的临床特点及治疗。方法选取2013年3月至2016年3月本院新生儿重症监护室收治的GBS相关新生儿化脓性脑膜炎患儿，对患儿的围产期因素、临床表现、实验室检查、治疗及转归情况进行回顾性分析。结果15例患儿中，早发型9例，晚发型6例，临床表现以发热、呼吸困难为主，伴随抽搐、拒乳、肌张力异常及休克等表现；所有患儿降钙素原均升高。脑脊液培养GBS阳性者8例，头颅MRI6例提示化脓性脑膜炎及其并发症改变，1例提示脑萎缩及脑白质发育不良等，脑电图异常者3例。结论无乳链球菌相关新生儿化脓性脑膜炎病情危重，易引起神经系统后遗症。根据患儿病情应及早进行脑脊液检查，选择强有力的抗生素治疗，必要时联合用药。

Objective To investigate the clinical features and treatment strategies of neonatal purulent meningitis associated with B streptococcus. Methods Neonates with GBS related neonatal purulent meningitis at the neonatal intensive care unit of our hospital were included from March 2013 to March 2016. The terinatal factors, clinical characteristics, laboratory examinations, treatment strategies, and outcomes were retrospectively analyzed. Results Fifteen cases were recruited, including 9 early-onset cases and 6 late-onset. The clinical manifestations were mainly fever and dyspnea, accompanied with convulsion, refusing milk, abnormal muscle tone, shock, etc. The serum level of procalcitonin elevated in all the cases. The CSF culture was GBS positive in 8 cases. Cranial MRI indicated meningitis encephalitis and complications in 6 cases, and brain atrophy and brain white matter dysplasia in one case. Three cases showed abnormal electroencephalogram. Conclusions Neonates with GBS-associated purulent meningitis are tending to be in critical conditions and cause neurological sequelae. It is imperative to perform cerebrospinal fluid examination in suspected cases and apply sensitive antibiotics in time or drug combination therapy when necessary.