| Objective:To analyze the clinical characteristics and related risk factors of neonatal refractory purulent meningitis.Methods:Retrospective analysis of clinical data of 141 hospitalized neonates diagnosed as neonatal purulent meningitis admitted to the neonatology department of Children’s Hospital of Kunming Medical University from January 1,2017 to December 31,2017.According to the bacterial culture results,the course of antibiotic treatment,the index of cerebrospinal fluid review and clinical symptoms,the patients were divided into general group(n=99)and refractory group(n=42).Parameters were compared between the two gruops using chi-square test,Student’s t-test and Wilcoxon rank sum test where appropriate,and possible influencing factors were selected for statistical analysis.Variables with statistical significance in univariate analysis were screened by Logistic regression analysis.Results:1.During the study period,the neonatology department of Children’s Hospital of Kunming Medical University were treated with 7727 cases,with 154 cases diagnosed neonatal purulent meningitis,accounting for 1.99%(154/7 727)of the children with the same period in the department,according to rule out standard removed 13 cases,141 cases included in the standard,the general group had 99 cases,the refractory group included 42 cases,neonatal refractory purulent meningitis accounted for 0.54%(42/7 727)of hospitalized children with the same period,two groups of children in the gender,gestational age,birth weight,onset age and birth of the amniotic fluid pollution situation.There were no statistical significance(p>0.05).2.The clinical manifestations of the two groups of children in the event of a fever,convulsions,respiratory symptoms(including cyanosis around the lip,cough,nasal resistance,sputum rang in the throat,spit,groans),digestive system symptoms(including anorexia,abdominal distension,vomiting,diarrhea,from milk),whether the pre-hospital anti-infection treatment.There were no statistical significance(p>0.05).3.Compared with the cerebrospinal fluid,infection index and the results of etiology in the refractory group and the general group,the increased white blood cell count,increased protein content and decreased sugar content in cerebrospinal fluid were more significant 850[127,2062.5]×106/L vs 26[18,51,5]×106/L,Z=7.494,1.08[0.61,1.477]mg/L vs 0.488[0.374,0.663]mg/L,Z=6.422,2.06[1.27,2.63]mmol/L vs 2.84[2.435,3.42]mmol/L,Z=5.164,all P<0.05,the increase rate of procalcitonin(PCT)was higher[57.14%(24/42)vs 34.34%(34/99),χ2=6.331,P<0.05],and the positive rate of cerebrospinal fluid and/or blood culture was higher[28.57%(12/42)vs 8.08%(8/99),χ2=12.17,P<0.001].The positive rate of cereb rospinal fluid and/or blood microbial examination was 14.18%,and the main pathogens were escherichia coli and Group B streptococcus(GBS).Logistic regression analysis showed that the glucose content of cerebrospinal fluid decreased,protein content increased,and imaging abnormalities pointed to refractory suppurative meningitis[OR=0.392,95%CI;0.167～0.922,OR=4.712,95%CI:1.11～19.998,OR=5.793,95%CI:1.982～16.932,all P<0.05].4.The incidence of imaging abnormalities in refractory suppurative meningi tis was higher[52.8%(22/42)vs 4.04%(4/99),2=42.669,P<0.001],especiall y the high rates of subdural effusion,ventricular enlargement and hydrocephalu s,which were statistically significant[19.5%(8/42)vs 2.02%(2/99),χ2=10.52,P=0.001],[16.67%(7/42)vs 1.01%(1/99),χ2=10.74,P=0.001],[7.14%(3/42)比 0,χ2=-,P=0.025].5.Once the child was diagnosed with neonatal purulent meningitis,initial anti-infection treatment apply for Penicillin(or Ampicillin Sodium and Sulbactam Sodium)for anti-infection treatment.Pathogenic bacteria culture was positive,based on the results of drug susceptibility to choose antibiotics,three days after treatment,the review of cerebrospinal fluid to evaluate treatment effect and then weekly review of cerebrospinal fluid,gram-positive bacterium infection of children to collect cerebrospinal fluid for the treatment of 14 days,gram-negative bacteria infection to collect cerebrospinal fluid for the treatment of 21 days,refractory group cases clinical symptoms improved,but still cerebrospinal fluid indicators have apparently unusual,not cure index,cases of normal group were cured.Compared with the general group,the refractory group needed anti-infection treatment for a long time lasted over 26 days.Conclusions:1.In the first time of refractory suppurative meningitis,the white blood cell count of cerebrospinal fluid was significantly increased,biochemical glucose was significantly decreased and protein was significantly increased.The positive rate of pathogen culture was higher,and the pathogenic bacteria were mainly Streptococcus agalactiae,followed by Escherichia coli.2.The venous blood PCT of refractory suppurative meningitis was significantly increased.3.Refractory suppurative meningitis subdural effusion,ventricular enlargement and high proportion of hydrocephalus. |
