新生儿细菌性脑膜炎临床特征和并发症危险因素分析

The analysis of clinical characteristics and risk factors for neonatal bacterial meningitis

目的探讨新生儿细菌性脑膜炎的临床特征及其发生并发症的危险因素,以便为早期诊断和治疗提供科学依据。方法回顾性收集2013年1月至12月本院新生儿科确诊的83例急性细菌性脑膜炎(NBM)患儿的临床资料,包括孕周、孕期母体情况、患儿年龄、临床表现、血液炎症指标(血白细胞计数、中性粒细胞比例、CRP、PCT)、脑脊液(CSF)指标(白细胞计数、糖、蛋白及细菌培养)及头颅影像学(CT/MRI)等。结果在83例NBM患儿中,75.9%为足月儿,脑脊液培养结果显示,59.1%(49/83)的患儿培养阴性,而40.9%(34/83)的患儿培养阳性。B组链球菌是最常见的病原体,占阳性培养结果的47.06%(16/34),其次是大肠埃希氏菌。NBM的临床表现不典型,除了发热之外,呻吟和气促是最常见首发症状,其次是食欲减退、哭泣减少和活动减少。通过头颅CT或MRI检查结果,将患儿分为无并发症组和并发症组,采用t检验进行组间比较,发现两组患儿在发热、惊厥、脑脊液白细胞数、蛋白、葡萄糖、培养阳性指标差异有统计学意义(P<0.05)。Logistic多因素回归分析表明,发热≥39℃、惊厥、脑脊液蛋白量增高、脑脊液培养阳性是NBM并发症发生的独立预测因素(P<0.05)。结论新生儿细菌性脑膜炎临床表现常不典型,B组链球菌和大肠埃希氏菌是最常见的病原体。发热高峰≥39℃、惊厥发作、脑脊液蛋白含量增高及脑脊液培养阳性是NBM发生并发症的相关危险因素。

Objective To investigate the clinical characteristics of neonatal bacterial meningitis(NBM)and to identify the risk factors associated with complications,thereby providing evidence to support early identification and proactive treatment strategies.Methods A retrospective study was conducted on 83 neonates diagnosed with acute bacterial meningitis and admitted to our hospital's neonatal department between January 2013 and December 2023.Data were collected which were included gestational age,maternal pregnancy history,neonatal age,clinical symptoms,blood inflammation indicators[white blood cell count,neutrophil ratio,C-reactive protein,procalcitonin(PCT)],cerebrospinal fluid(CSF)analysis(white blood cell count,sugar,protein levels,and culture results),and head imaging findings[computed tomography,CT/magnetic resonance imaging(MRI)].Results A total of 83 cases were diagnosed as NBM.Of these,75.90%were full-term infants.The CSF culture results were negative in 59.1%(49/83)and positive in 40.9%(34/83)of the cases.Group B Streptococcus was the most common pathogen,accounting for 47.06%(16/34)of all positive cultures,followed by Escherichia coli.Clinical symptoms of NBM were often atypical;fever,irritability,and respiratory distress were the most common initial symptoms,followed by poor feeding,decreased activity,and reduced crying.Based on head CT or MRI findings,the patients were divided into two groups:uncomplicated and complicated.The t-test was used to compare these groups and found statistical differences in fever,seizures,CSF white blood cell count,CSF protein levels,CSF glucose levels,and positive CSF culture rates.A logistic multivariate regression analysis was performed,including all variables and identified fever≥39℃,seizures,increased CSF protein levels,and positive CSF cultures as independent predictors of complications in NBM(P<0.05).Conclusion The clinical manifestations of NBM frequently present atypical,making early diagnosis challenging.The most frequently identified pathogens are Group B streptococcus and Escherichia coli.The study identified several risk factors associated with complications in NBM,including a fever peak of 39℃or higher,the occurrence of convulsions,an increased protein content in CSF and a positive CSF culture.These factors are determined to be independent predictors of complications through a logistic multivariate regression analysis,which can be crucial for guiding clinical management and treatment strategies in affected neonates.