Study On The Relative Factors Of Abnormal Cerebrospinal Fluid Results In Febrile Neonates

BackgroundThe development of the nervous system with neonatal is not mature,the development of blood brain barrier is not perfect,its resistance and compensatory ability is poor,prone to intracranial infection.At present,there is no uniform diagnostic criteria for neonatal intracranial infection.Intracranial infection can cause the meninges and brain of the children with extensive parenchymal inflammatory lesions,leading to brain cell edema and intracranial hypertension,meningeal irritation sign,even cerebral hernia formation,so that children left a variety of neurological sequelae,such as intelligence backwards,limb paralysis,epilepsy and so on.Therefore,it is very important to find out whether there is any intracranial infection in the early stage of the fever,and the cerebrospinal fluid examination is the important basis for the diagnosis of intracranial infection.Lumbar puncture(LP)is a non-invasive,there are certain risks: like outside nerve and soft tissue injury,intracranial pressure syndrome,secondary infection,intracranial pressure rise higher,serious when can cause cerebral hernia,coma,even breathing cardiac arrest and unforeseen other opinion.Neonatal fever easily complicated with intracranial infection and its clinical manifestations are not specific,therefore,should be early diagnosis and treatment,clinical often need for lumbar puncture examination.At present,a result of cerebrospinal fluid abnormalities associated with what clinical factors necessary to study these factors and underwent lumbar puncture is relatively small.ObjectiveThe clinical features of neonatal fever research,comparative analysis of difference between fever neonatal cerebrospinal fluid results normal CSF and the abnormal clinical features and laboratory examination results,to explore the fever of the newborn ofcerebrospinal fluid(CSF)results related to abnormal risk factors,in order to guide the clinical treatment of fever newborns reasonable lumbar puncture.MethodsUsing retrospective cohort study method,527 patients with fever in the neonatal unit of our hospital from March 2014 to October 2015 were selected as the study subjects,to study the clinical characteristics of fever neonates,and to observe whether the cerebrospinal fluid(CSF)in the patients with fever were divided into normal group(control group)and cerebrospinal fluid(observation group).Will of fever in children with the highest temperature,continuous time,fever days age,lumbar puncture of peripheral blood high white blood cell count and high sensitive C reactive protein numerical,lumbar puncture before the use of antibiotics in time,blood culture,pathogen infection,nervous system complications such as,with congenital disease foundation,gestational age,mode of delivery,premature rupture of membranes early broken,Apgar score,birth weight and other clinical data were analyzed,according to the single factor analysis and the difference between the two groups.Logistic regression analysis was used to study the related risk factors of abnormal cerebrospinal fluid.According to the results of statistical analysis,the related factors of the abnormal cerebrospinal fluid results were determined.P<0.05 indicated that there was statistical significance.ResultsIn this group,527 cases were examined by lumbar puncture,and there were 126 cases with abnormal cerebrospinal fluid examination,the proportion was 23.91%.Bacteria and using logistic regression analysis showed that,the following factors for neonatal fever cerebrospinal fluid results an independent risk factor for abnormal: fever and the highest temperature >38.5℃(OR: 2.651,95%CI: 1.672-4.099),fever days age less than or equal to 9 days(OR: 0.672,95%CI: 0.654-1.004)continued 3days(OR: 1.052,95%CI:1.047-1.242),bacterial infection(OR: 2.779,95%CI: 1.627-4.882),the virus infection in infected(OR: 8.671,95%CI: 1.672-4.099),atypical bacteria(OR: 1.561,95%CI:5.638-17.062)and lumbar puncture infection before using membranes and antibiotics in the number of days is less than or equal to 2d(OR: 2.645,95%CI: 1.472-3.038),premature rupture of membranes(OR: 1.240,95%CI: 1.156-2.219).ConclusionsFor neonatal fever,persistent fever 3days,temperature >38.5℃,fever days age less than or equal to 9 days,lumbar puncture before using antibiotic is less than or equal to 2d and membranes,premature rupture,bacterial infection,virus infection and atypical bacteria infection fever neonatal lumbar puncture cerebrospinal fluid examination results abnormal independent risk factors,for the existence of these factors the fever of the newborn,underwent lumbar puncture is necessary and the early diagnosis of intracranial infection and timely treatment is beneficial.