不同种类病原体导致的新生儿中枢神经系统感染临床及实验室特征分析

Analysis of clinical and laboratory characteristics of neonates with central nervous system infection caused by different types of pathogens

目的分析不同种类病原体导致的新生儿中枢神经系统(central nervous system,CNS)感染的临床特征、实验室检查及临床转归。方法回顾性收集2020年1月1日—2022年12月31日河北省儿童医院新生儿重症监护室收治并明确病原体的CNS感染患儿的病历资料,依据病原学结果分为细菌性脑膜炎(bacterial meningitis,BM)与病毒性脑膜炎(viral meningitis,VM)组,比较2组的临床特征、实验室结果及转归。结果共纳入63例患儿,BM组38例,VM组25例,胎龄中位值38.3(3.0)周,足月儿47例(74.6%),男性37例(58.7%),平均出生体重(2970±731)g,发病日龄中位值为9.6(11.0)d,主要临床表现包括发热(55例,87.3%)、黄疸(29例,46.0%)、吃奶差(20例,31.7%)、肌张力异常(20例,31.7%)等,2组一般临床特征及临床表现差异无统计学意义(P>0.05)。BM组脑脊液(cerebrospinal fluid,CSF)白细胞(white blood cell,WBC)计数、WBC异常比例、多核细胞百分比、蛋白水平及血WBC计数、中性粒细胞百分比、CRP及CRP>8 mg/L的比例均显著高于VM组(P<0.05)。BM组CSF WBC范围在6~258233个/mm^(3)之间,1例CSF WBC低于20个/mm^(3)。VM组CSF WBC范围在1~1238个/mm^(3)之间,2例CSF WBC高于1000个/mm^(3),9例低于20个/mm^(3)。BM组病原体以大肠埃希菌(11例,28.9%)、肺炎克雷伯菌(6例,15.8%)最常见。VM组病原体以肠道病毒最常见(15例,60%)。随访结果显示BM组1例死亡,3例遗留严重的神经系统后遗症,VM组3例死亡,1例遗留严重的神经系统后遗症,其余全部预后良好。结论仅通过临床特征难以区分新生儿CNS感染是由细菌或病毒所致,常规实验室检查在判断致病病原体上有一定帮助,开展包含病毒靶标在内的脑脊液病原检测对实现精准治疗及改善预后至关重要。

Objective To analyze the clinical features,laboratory tests and clinical outcomes of neonates with central nervous system(CNS)infection caused by different types of pathogens.Methods Collected the medical records of neonates with central nervous system(CNS)infection caused by specific pathogens who were admitted to the NICU of Hebei Children′s Hospital from January 1,2020,to December 31,2022.Based on their pathogen results,the patients were divided into bacterial meningitis(BM)group and viral meningitis(VM)group.The clinical features,laboratory results and outcomes were compared between the two groups.Results A total of 63 eligible neonates were enrolled,including 38 patients in BM group and 25 in VM group.The median gestational age was 38.3(3.0)weeks,including 47 full-term infants(74.6%)and 37 males(58.7%).The neonates had a mean birth weight of(2970±731)g and the median age of onset was 9.6(11.0)d.The clinical manifestations were fever(n=55,87.3%),jaundice(n=29,46.0%),poor feeding(n=20,31.7%)and dystonic abnormalities(n=20,31.7%).There was no significant difference in general clinical features and clinical manifestations between the two groups(P>0.05).Cerebrospinal fluid(CSF)white blood cell count(WBC),abnormal ratio of WBC,percentage of polymorphonuclear cells,protein levels and blood WBC,percentage of neutrophils,C-reactive protein(CRP)and percentage of CRP>8 mg/L were higher in the BM group than that in the VM group(P<0.05).In the BM group,the CSF WBC ranged from 6 to 258233/mm^(3),which was below 20/mm^(3) in one infant.In the VM group,the CSF WBC ranged from 1 to 1238/mm^(3),which was above 1000/mm^(3) in two infants and below 20/mm^(3) in nine infants.E.coli(n=11,28.9%)and Klebsiella pneumoniae(n=6,15.8%)were the most common pathogens in BM group,and enterovirus(n=15,60%)was the most common in VM group.The follow-up results showed that there was 1 death(2.6%)and 3 patients(7.9%)with severe neurological sequelae in the BM group,and 3 death(12%)and 1 patient(4%)with severe neurological sequelae in the VM group;The remaining patients had a good prognosis.Conclusion It is difficult to differentiate whether neonatal CNS infection is caused by bacteria or virus solely based on clinical features.Routine laboratory tests can be helpful to some extent in identifying pathogenic pathogens.It is crucial to detect pathogen in CSF,including viral targets,to achieve precise treatment and improve prognosis.