新生儿脑脓肿五例临床分析

Clinical analysis of five cases of neonate brain abscess

目的总结新生儿脑脓肿的临床特点,提高对该病的认识。方法回顾性分析2018年12月至2021年3月郑州大学第一附属医院收治的5例新生儿脑脓肿的院内和随访资料。结果5例患儿中,早产儿4例,足月儿1例;女3例,男2例。发病日龄依次为出生后10、5、2、28、11 d,均以发热为首发表现,3例患儿血液或脑脊液培养阳性,头颅影像学确诊脑脓肿,病变部位以额叶最常见。1例患儿内科保守治疗,4例患儿行脓肿穿刺抽吸及引流术;5例患儿治疗后病变范围较治疗前均有所减小,临床症状好转。出院后行神经发育评估3例未发现智力和运动落后,现发育同同龄人,2例遗留不同程度的神经系统后遗症。结论新生儿脑脓肿的临床特征缺乏特异性,对于治疗效果差或病情反复的新生儿败血症和脑膜炎患儿应尽早行头颅影像学检查,提高早期诊断率,改善远期预后。

Objective To summarize the clinical characteristics of neonatal brain abscess and improve the understanding of diagnosis and treatment of this disease.Methods Clinical data of five cases of neonatal brain abscess admitted to the First Affiliated Hospital of Zhengzhou University from December 2018 to March 2021 were retrospectively analyzed and followed-up.Results Among five cases,four cases were premature and one was term infant,three were girls and two were boys.The age of onset was 10,5,2,28 and 11 days after birth,and all had fever as the first manifestation.Three cases had positive blood or cerebrospinal fluid cultures,and the diagnosis of brain abscess was confirmed by head imaging,with the most common lesion being in the frontal lobe.One case was treated conservatively,and four cases underwent abscess aspiration and drainage.After treatment,the range of lesions in five cases was reduced and the clinical symptoms were improved.The neurodevelopmental assessment after discharge did not reveal any intelligence or motor retardation in three cases,and were developing as the same age,while the other two cases had various degrees of neurological sequelae.Conclusion The clinical characteristics of neonatal brain abscess are not specific,so it is necessary to conduct head imaging examination as early as possible for neonates with septicemia and meningitis with poor therapeutic effect or recurrent disease,so as to improve the early diagnosis rate and long-term prognosis.