新生儿化脓性脑膜炎43例住院期间临床结局分析

Outcomes of 43 hospitalized neonates with purulent meningitis

目的探讨引起新生儿化脓性脑膜炎死亡等不良结局的高危因素。方法选取2005年1月1日至2015年12月31日入住扬州大学附属医院的43例新生儿化脓性脑膜炎患儿,分为结局良好组(17例)和结局不良组(26例)。通过查阅病历获取患儿脑脊液(CSF)常规、生化、细菌培养、C反应蛋白,血常规,血培养,头颅CT或MRI,脑电图,听力筛查等临床资料,总结患儿临床表现、新生儿化脓性脑膜炎构成、CSF细菌培养结果和临床结局。采用logistic回归、Wald检验分析新生儿化脓性脑膜炎结局不良的高危因素。结果新生儿化脓性脑膜炎临床表现不典型,表现为非特异性感染症状。43例新生儿化脓性脑膜炎中,早发型14例,晚发型29例。CSF细菌培养阳性8例,培养阳性率18.60%,培养出的细菌分别为肺炎克雷伯菌3例(37.50%),金黄色葡萄球菌2例(25.00%),大肠埃希菌1例(12.50%),产气肠杆菌1例(12.50%)阪崎肠杆菌1例(12.50%)。在43例患儿临床结局方面,死亡6例,总病死率为13.95%。其他不良结局包括:中重度颅内出血7例(16.28%)、运动障碍4例(9.30%)、脑白质广泛受损4例(9.30%)、脑积水3例(6.98%)、脑液化坏死2例(4.65%)、脑软化萎缩2例(4.65%)、癫痫2例(4.65%)、听力障碍2例(4.65%)。通过logistic回归分析结局不良高危因素为:CSF蛋白> 3000 mg/L(OR为5.30,95%CI为1.51-172.99,Wald检验P=0.01);外周血白细胞<5.0×10~9/L(OR为5.02,95%CI为1.43-224.89,Wald检验P=0.03);CSF细菌培养阳性(OR为4.02,95%CI为1.08-787.44,Wald检验P=0.03)。结论新生儿化脓性脑膜炎病死率及后遗症发生率高。CSF蛋白> 3000 mg/L、外周血白细胞<5.0×10~9/L、CSF细菌培养阳性为新生儿化脓性脑膜炎结局不良的高危因素。

Objective To identify the risk factors for the sequela and death in neonates with purulent meningitis.Methods Forty-three neonates with purulent meningitis were selected at Affiliated Hospital of yangzhou University from January 1,2005 to December 1,2015.Based on the prognostic status,the patients were divided into a good prognosis group(n=17)and a poor prognosis group(n=26).Clinical information such as routine cerebrospinal fluid(CSF)tests,biochemistry tests,bacterial culture,CRP,CBC,blood culture,skull CT or MRI data was collected from medical records.Clinical manifestation,pathogen composition of neonatal purulent meningitis,CSF culture,and clinical outcome were summarized.Logistic analysis and Wald test were used to identify the risk factors for the sequela and death in neonates with purulent meningitis.Results Neonatal purulent meningitis had atypical clinical manifestations and often manifested as nonspecific infection.CSF culture was positive in eight(18.60%)cases,including three(37.50%)cases of Klebsiella pneumoniae infection,two(25.00%)cases of Staphylococcus aureus infection,one(12.50%)case of Enterobacter aerogenes infection,one(12.50%)case of Escherichia coli infection,and one(12.50%)case of Enterobacter sakazakii infection.Six patients died,with a mortality rate of 13.95%.Other adverse outcomes included moderate-to-severe intracranial hemorrhage in seven(16.28%)cases,dyskinesia in four(9.30%),white matter lesions in four(9.30%),hydrocephalus in three(6.98%),cerebral necrosis in two(4.65%),cerebral softening in two(4.65%),epilepsy in two(4.65%),and dyskinesia in two(4.65%).The logistic analysis showed that the risk factors for the poor prognosis were cerebrospinal fluid protein concentration>3000 mg/L(OR=5.30,95%CI=1.51-172.99,P=0.01),peripheral white blood cells<5.0×10^9/L(OR=5.02,95%CI=1.43-224.89,P=0.03)and positive CSF culture(OR=4.02,95%CI=1.08-787.44,P=0.03).Conclusion The mortality and sequela rates of neonatal purulent meningitis are high.CSF protein concentration>3000 mg/L,peripheral white blood cells<5.0×109/L,and positive CSF culture are risk factors for poor prognosis of neonatal purulent meningitis.