Clinical characteristics in 70 cases of neonatal refractory purulent meningitis
Wang Yi, Hu Xuhong, Zeng Wen, et al
Department of Neonatology, Chengdu Women’s & Children’sCentral Hospital, School of Medicine, University of Electronic Science and Technology of China, Sichuan,Chengdu 611731, China
Abstract: 【Abstract】 Objective To explore the clinical characteristics of refractory purulent meningitis in neonates,and provide clues for clinical management. Methods Clinical data of neonatal refractory purulent meningitis admitted from January 2017 to June 2020 were analyzed retrospectively. A total of 374 cases of neonatal purulentmeningitis were diagnosed, of which 72 cases were refractory neonatal purulent meningitis. Two cases withcongenital malformations were excluded, and 70 cases were included in this study. 70 cases were divided intopreterm group (gestational age <37 weeks, 21 cases) and full-term group (gestational age ≥37 weeks, 49 cases)according to gestational age. The clinical characteristics (gender, gestational age, birth weight, age of onset,treatment duration, clinical symptoms), laboratory examination (routine blood test, pathogen culture, examinationof cerebrospinal fluid), and results of magnetic resonance imaging (MRI) of two groups were compared. χ2 test, t-test,and Mann-Whitney test were used for statistical analysis. Results In the 70 cases, the average duration formeningitis therapy was (33±12) d, the median age of onset was 6.5 (3.00, 17.25) d, and the onset time in premature group was earlier than full-term group [4.0 (0.0, 11.5) vs 8.0 (4.5, 18.0) d, Z = -2.314, P<0.05]. Among the 70cases, 50 cases (71.4%), 4 cases (5.7%), 20 cases (28.6%), and 3 cases (4.3%) had fever, convulsion, respiratory symptoms, and shock, respectively. The incidence of fever in full-term group was higher than that in preterm group[85.7% (42/49) vs 38.1% (8/21), χ2=16.333, P<0.05]; there were 3 cases of shock in preterm group, but no shock infull-term group (P<0.05); there was no significant difference in the incidence of seizure and respiratory symptomsbetween the two groups (P>0.05). The average peripheral blood platelet count in preterm group was lower than thatin term group [(205±179) ×109 vs (300±165) ×109/L, t=2.145, P<0.05], and the incidence of abnormal plateletcount in preterm group was higher than that in full-term group [38.1% (8/21) vs 10.2% (5/49), χ2=5.830, P<0.05];while there was no significant difference in white blood cell count and C-reactive protein between the two groups(P>0.05). The preterm group had higher cerebrospinal fluid (CSF) protein than full-term group [(2.17±1.03) vs(1.57±1.01) g/L, t=2.238, P<0.05] , while the CSF glucose was significantly lower than full-term group [1.73 (0.85,2.50) vs 2.45 (1.83, 2.80) mmol/L, Z= -2.012, P<0.05]. The number of nucleated cells in CSF of the two groups [332 (106, 2 454) ×106 and 226 (77, 553) ×106/L] was significantly higher than the normal range. Among 70 cases, 9 cases (12.9%) were positive in CSF culture and 12 cases (17.1%) were positive in blood culture. Escherichia coli and group B Streptococcus were the most common bacteria. Abnormal findings were found in 74.3% (52/70) of cranial MRI. The outcomes of these neonates were: 87.1% (61/70) were cured, 4.3% (3/70) improved, and 8.6%(6/70) discontinued treatment and discharged from hospital. Conclusions The clinical symptoms of neonatal purulent meningitis are not typical. It is necessary to be aware of intracranial infection if a neonate has fever.Escherichia coli and group B streptococcus are most common in refractory cases. In addition, we should be alert todrug-resistant bacterial infections.
2021, Vol. 9 
