MRI Findings And Prognosis Of Purulent Meningitis In Neonates

Objective:The features and prognosis of head MRI(conventional MRI and DWI)in neonatal purulent meningitis were analyzed retrospectively to guide clinical practice.Method:Collect and analyze retrospectively clinical dates of purulent meningitis in neonate wards of soochow university affiliated children’s hospital between January 2016 and October 2018.A total of 87 cases were selected according to inclusion criteria and exclusion criteria.Clinical data,laboratory examination and imaging data of the other 87 children were collected.According to the time of initial cranial MRI,the patients were divided into the less than two-week group and the more than two-week group.According to the MRI results,the children were assign into the complication group and the non-complication group.The patient’s family was informed by phone to bring the child to the department of child healthcare of our hospital for "neuropsychological development examination for children aged 0-6 years" to evaluate the development quotient(DQ).70 cases completed the scale.Children with DQ less than 85 or who died were included in the adverse prognosis group,and those with DQ greater than or equal to 85 were included in the recovery group.By SPSS20 software package for data analysis,the categorical analysis by chi-square test or Fisher’s exact probability method,numberical variable by t test or rank sum test,through the single factor analysis to select the risk factors for complications of purulent meningitis,by single factor and multiple factors analysis to choose the risk factors for poor prognosis of purulent meningitis.Result:47 cases were found to have neurological complications for the first skull MRI in 87 cases of neonatal purulent meningitis,abnormal rate was 54.0%,including 13 cases of subdural effusion(27.7%),18 cases of intracerebral hemorrhage(38.3%),7 cases of encephalomalacia(14.9%),5 cases of hydrocephalus(10.6%),2 case of scerebral infarction(4.3%),5 cases of ventricular tube membrane inflammation(10.6%),3 patients of abnormal signal(6.4%).The abnormal rate of magnetic resonance examination within two weeks of diagnosis of purulent meningitis was 62.5%,and the abnormal rate of magnetic resonance examination after two weeks was 38.7%,which was statistically significant.There were statistical differences in the fever lasts for more than 5 days(P=0.048),convulsions(P=0.026),CSF protein concentrtion>2000mg/L(P=0.020),and CSF sugar concetration<1.1mmol/L(P=0.023)between the two groups with and without complications.There were statistical differences in convulsion(P=0.024),CSF protein concentrtion>2000mg/L(P=0.022)and CSF sugar concetration<1.1mmol/L(P=0.012)between the two groups with and without sequelae.Conclusion:1.In this study,the MRI main complications of neonatal purulent meningitis included subdural effusion,encephalomalacia,cerebral hemorrhage.MRI examination within two weeks of diagnosis was more likely to reveal relevant abnormalities.2.In this study,the fever lasts for more than 5 days,convulsions,CSF protein concentrtion>2000mg/L and CSF sugar concetration<1.1mmol/L were the risk factors for complication of neonatal purulent meningitis.3.In this study,convulsions,CSF protein concentrtion>2000mg/L and CSF sugar concetration<1.1mmol/L were the risk factors for adverse outcome of neonatal purulent meningitis,among which the significant risk factors for poor prognosis were convulsions.