早发型与晚发型新生儿化脓性脑膜炎的临床分析

Clinical analysis of early-onset and late-onset neonatal purulent meningitis

目的探讨早发型与晚发型新生儿化脓性脑膜炎的临床特征。方法回顾性分析2019年1月至2021年1月在济宁医学院附属医院儿科住院的112例确诊为新生儿化脓性脑膜炎患儿的临床数据,根据发病年龄分为早期新生儿组(n=54)和晚期新生儿组(n=58),比较两组患儿一般情况、母孕期情况、临床表现及实验室检查。结果早期新生儿组出生体重、胎龄低于晚期新生儿组,母亲孕晚期感染及胎膜早破发生率高于晚期新生儿组,脑脊液蛋白明显高于晚期新生儿组(P<0.05)。早期新生儿组临床多表现为反应差、嗜睡、呼吸困难、吃奶差,晚期新生儿组临床表现以发热多见,降钙素原明显高于早期新生儿组(P<0.05)。两组患儿其他化验指标包括外周血白细胞计数、C反应蛋白及脑脊液糖、脑脊液白细胞计数比较,差异无统计学意义(P>0.05)。结论早发型新生儿化脓性脑膜炎多见于早产儿、低出生体重儿,常合并孕晚期感染或胎膜早破,临床表现不典型,对合并感染高危因素、高度怀疑颅内感染的患儿应积极完善脑脊液检查,争取早期诊断,及时有效治疗,降低病死率,改善预后。

Objective To investigate the clinical features of early-onset and late-onset neonatal purulent meningitis.Methods The clinical data of 112 infants diagnosed asneonatal purulent meningitis hospitalized in the Department of Neonatology in the Affiliated Hospital of Jining Medical University from January 2019 to January 2021 were retrospectively analyzed.According to the onset age,these infants were divided into the early neonatal group and the late neonatal group.The general conditions,conditions during pregnancy,clinical manifestations and laboratory examinations of infants in the two groups were compared.Results The birth weight and gestational age of the early neonatal group were lower than that of the late neonatal group,the incidence of maternal infection and premature rupture of membranes in the late pregnancy group was higher than that of the late neonatal group,and the cerebrospinal fluid protein was significantly higher than that of the late neonatal group(P<0.05).The clinical manifestations of the early neonatal group were poor reaction,lethargy,dyspnea and poor feeding.The clinical manifestations of the late neonatal group were mainly fever,and procalcitonin was significantly higher than that of the early neonatal group(P<0.05).There was no significant difference between the two groups in other laboratory indexes including peripheral blood leukocyte count,C-reactive protein,cerebrospinal fluid sugar and cerebrospinal fluid leukocyte count(P>0.05).Conclusion Early-onset neonatal purulent meningitis is more common in premature infants and low birth weight infants,often complicated with late pregnancy infection or premature rupture of membranes,and its clinical manifestations are atypical.For infants complicated with high risk factors of infection and high suspicion of intracranial infection,cerebrospinal fluid examination should be improved to strive for early diagnosis and timely and effective treatment,so as to reduce mortality and improve prognosis.