早发型新生儿细菌性脑膜炎的临床特征

Clinical Characteristics of Early Onset Neonatal Bacterial Meningitis

摘要: 目的：探讨新生儿细菌性脑膜炎(neonatal bacterial meningitis, NBM)早发型的临床特征。方法：收集2017年9月~2022年9月在青岛妇女儿童医院NICU住院治疗诊断NBM的新生儿(57例)及其母亲的临床资料。根据发病时间是否在生后7天内将新生儿分为早发组(27例)，晚发组(30例)；再根据胎龄分为早期早产儿组(胎龄 < 32周)、中晚期早产儿组(37 > 胎龄 ≥ 32周)及足月儿组(胎龄 ≥ 37周) 3个亚组。数据分析包括母亲信息、围产期资料、患儿的临床表现、实验室检查结果、住院时间和脑脊液3次检查结果变化情况。结果：早发组在母亲产前发热发生率大于晚发组，脐带炎发生率高于晚发NBM组(P < 0.05)；在脑脊液WBC数值、脑脊液蛋白定量方面早发组低于晚发NBM组，早发组患儿脑脊液恢复所需时间长于晚发组，差异有统计学意义(P < 0.05)；在脑脊液白细胞随时间变化的比较上，晚发组脑脊液中白细胞计数变化较早发组下降更明显，说明在同样治疗时间下，晚发组的治疗效果优于早发组。结论：母亲有产前发热病史，胎盘病理结果提示脐带炎的患儿可能更容易发生早发型NBM，临床表现常以发热及反应差为主，同时我们也发现早发型NBM患儿治疗效果更差，脑脊液恢复所需要的时间更长。注意母亲产前状态，及时完善胎盘病理检查和相关实验室检查可能有助于NBM的早期识别。

Abstract: Objective: To investigate the clinical characteristics of early onset bacterial meningitis in neonates. Methods: Clinical data of newborns (30 cases) and their mothers who were hospitalized and diag-nosed with NBM in the NICU of Qingdao Women and Children’s Hospital from September 2017 to September 2022 were collected. Neonates were divided into early-onset NBM group (27 cases) and late-onset NBM group (30 cases) according to whether the onset was within 7 days; according to gestational age, they were divided into three subgroups: early preterm infants group (gestational age < 32 weeks), middle and late preterm infants group (37 > gestational age ≥ 32 weeks) and term infants group (gestational age ≥ 37 weeks). Data analysis included: information on the mother, per-inatal data, clinical manifestations of the child, laboratory results, length of stay and the results of 3 tests cerebrospinal fluid. Results: The incidence of prenatal fever in early onset group was higher than that in late onset group, and the incidence of umbilical cord inflammation was higher than that in late onset NBM group (P < 0.05). The WBC value and protein quantity of CSF in early onset group were lower than those in late onset NBM group, and the recovery time of CSF in early onset group was longer than that in late onset group, the difference was statistically significant (P < 0.05). In comparison with the changes of CSF white blood cells over time, the changes of CSF white blood cell count in the late onset group showed a downward trend compared with the early onset group, indi-cating that the treatment effect of the late onset group was better than that of the early onset group. Similar results were found in the group of late preterm and term infants. Conclusion: The mother has a history of prenatal fever, and the pathological results of placenta suggest that children with umbilical cord inflammation may be more prone to early-onset NBM, and the clinical manifestations are usually fever and poor reaction. Meanwhile, we also found that the treatment effect of children with early-onset NBM is worse, and it takes longer time for the cerebrospinal fluid to recover. At-tention to maternal prenatal status, timely improvement of placental pathology and related labor-atory tests may contribute to the early identification of NBM.