Clinical Analyses Of 48 Cases Of Neonatal Bacterial Meningitis

Objective:To study the clinical features and treatment of neonatal bacterial meningitis (BM).Method:clinical materials were collected and analyzed in 48 newborns suffering from BM, who were medically treated in affiliated children's hospital of Zhejiang University School of Medicine from January 1st 2009 to December 31st 2010. Newborns were divided into two groups,16 cases of early newborn, and 32 cases of late newborn.Results:Fever and poor feeding were major clinical features, neurological symptoms in early newborn were less typical than that in late newborn. Complications of CNS were intracranial hemorrhage, ependymitis, subdural effusion, hydrocephalus.Other main complications include septicemia, acute rotavirus enteritis. CSF findings consisted of polymorphonuclear pleocytosis (more than 20/mm3,47 of the 48cases), hypoglycorrhachia (less than 1.1mmol/L,9 of the 48cases), and elevated CSF protein levels (higher than 1.5g/L,23 of the 48cases). Blood routine examination showed leukocytosis (more than 12* 109/L,31 of the 48cases), mainly neutrophil, CRP significantly increased(higher than 8mg/L,35 of the 48 cases). Blood culture showed 14 of the 48 case positive, CSF culture showed 9 cases positive, the main pathogens were Escherichia coli, staphylococcus aureus, and Streptococcus agalactiae, Listeria monocytogenes, and others. The positive rate of late newborn was higher than that of early newborn.17 cases were evaluated by Brainstem auditory evoked potentials or otoascoutic emissions, and 4 cases were found Abnormal. Empirical therapy included penicillins and cefotaxime or ceftriaxone,24 cases using meropenem,12 cases using vancomycin. Adjunctive therapies include dexamethasone, intravenous immunoglobulin (IVIG), mannitol, Phenobarbital. The outcomes were as follows:41 cases were cured, while 7 gave-up, and with no case dead. In the 41 cases cured, the mean time of body temperature normalization was 7.20±8.16days, the mean time of CSF normalization was 7.20±8.16 days, and the average hospital stay was 22.90±10.74 days, with no significant difference between two groups (p>0.05)。Conclusion:The clinical presentations of Neonatal bacterial meningitis is non-specific, especially in early neonatal period. Positive rate of bacterial culture of the newborn is relatively low, so one should pay attention to the earlier diagnosis, control the infection positively, and monitor the laboratorial index regularly and follow the development of the disease. Acute intervention may be necessary to prevent the possible complications.