The Analysis Of Clinical Characteristics Between Preterm And Full-Term Neonates Purulent Meningitis

Objective:To study the clinical characteristics of neonates purulent meningitis,to compare and analysis the clinical characteristics’ s specificity of purulent meningitis between preterm and full-term neonates. fighting for early diagnosis and reasonable treatment.Methods:Summarized the clinical characteristics of 66 neonates with purulent meningitis from July 2009 to July 2015. They were divided into preterm group(<37 weeks) and full-term group(37-42 weeks) according to gestational age. And the clinical characteristics of these two groups were compared and analysis.Two groups of perfecting the related inspection after admission,including blood routine examination,CRP,cerebrospinal fluid、cerebrospinal fluid cultivation,blood specimen,etc.Results:The mainly clinical manifestations of neonatal purulent meningitis were fever, poor response, poor eating milk, convulsions, lethargy, irritability, cranial suture broadening, lower or higher muscular tension. For full-term neonates the common manifestations were fever, poor response and convulsions and for preterm were lower muscular tension. preterm infants usually were infected in hospital and full-term infants were community. Glucose in cerebrospinal fluid significantly decreased in preterm group compared with full-term group. And protein in cerebrospinal fluid was significantly increased in preterm group.Conclusion:Neonatal purulent meningitis is short of specificity, especially in preterm infants. Fever, poor reaction and twitch are more common in full-term infants, while hypotonia is more common in premature babies, maybe relating to their poorly developed thermoregulatory system and nervous system. So, we should observe closely in clinical work, and ensure early diagnosis, early treatment. Examination of cerebrospinal fluid is the main standard for diagnosis of PM. The content of glucose in CSF of the premature group is obviously lower than that of the full-term infant group in this study. Considering that that may be influenced by the factors such as their poorly developed blood vessel of brain and they are easily infected, which can lead to the change of the CBF and intracranial pressure, and then the low content of glucose in CSF, we infer that it may be related to the incidence of cerebral injury of premature babies. The content of protein in CSF of the premature group is substantially higher than that of the full-term infant group. We consider that it may be related to the fact that the development of blood brain barrier of premature babies is less perfect than that of full-term infants. Because the fluctuation of albumen quantities is bigger several days after they are born, the infection caused by PM may lead to the increase of permeability of BBB, which will then cause the increase of protein in cerebrospinal fluid. Cerebrospinal fluid culture is the gold standard of diagnosis. But, its positive rate is low. In the study, there are only 5 cases(7.6%) of the whole 66 cases who are positive in cerebrospinal fluid culture, which is similar to domestic and international reports. Pitifully, the positive are only in full-term infant group, which may be related to the fact that the PM of premature babies is basically due to hospital infection, and they have already used antibiotics before the lumbar puncture. But, full-term infants have the l.p. timely when they are into the hospital and have their cerebrospinal fluid culture improved. So, we conclude that the positive rate when cerebrospinal fluid culture is conducted before the use of antibacterials is higher than that after the use of antibacterials, which is coincided with the relational reports. Therefore, to diagnose PM definitely, the cerebrospinal fluid culture should be conducted before the use of antibacterials. So we will detection early as far as possible.