不同情况新生儿细菌性脑膜炎的住院情况及近期预后分析
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摘要
目的了解不同胎龄、不同发病时间的新生儿细菌性脑膜炎患儿的住院情况及近期预后。方法选取90例新生儿细菌性脑膜炎作为研究对象,按照不同胎龄、不同发病时间进行分组,通过比较新生儿神经行为测定(NBNA)评分、听力筛查、头颅CT、头颅MRI、振幅整合脑电图等来评估患儿的近期预后。结果 (1)将90例细菌性脑膜炎患儿按胎龄分为早产组(41例)和足月组(49例),早产组男性28例(68. 29%),足月组男性23例(46. 94%),两组性别差异有统计学意义(P=0. 042)。早产组发病日龄为16. 0(6. 5,31. 0) d,足月组发病日龄为7. 0(1. 5,12. 0) d,差异有统计学意义(P <0. 001)。早产组住院总时长(53. 41±28. 50) d,足月组住院总时长(25. 53±13. 27) d,两组差异有统计学意义(P <0. 001)。早产组NBNA评分异常比例为57. 14%,足月组NBNA评分异常比例为81. 82%,差异有统计学意义(P <0. 05)。早产组治愈出院共33例,未愈出院共7例,死亡1例,足月组治愈出院共28例,未愈出院共16例,死亡4例,两组出院时情况的差异有统计学意义(P <0. 05)。(2)将90例细菌性脑膜炎患儿按发病时间不同分为早发组(23例)和晚发组(67例),早发组NBNA异常比例占89. 47%,晚发组NBNA异常比例占61. 90%,两组差异有统计学意义(P <0. 001)。两组病例在胎龄构成、住院总时长、平均日住院费用、头颅MRI/CT异常比例、振幅整合脑电图(a EEG)异常比例、听力筛查异常比例、出院时情况的比较上,差异均无统计学意义(P> 0. 05)。结论在细菌性脑膜炎患儿中,与足月儿相比,早产患儿男性病例更多,细菌性脑膜炎发病日龄更晚,住院总时间更长,NBNA评分异常比例较低,出院时治愈出院比例更高,死亡比例更低。早发感染的病例与晚发感染的病例相比较,早发组NBNA评分异常比例较晚发组高。
Objective To analyze the hospitalization and short-term prognosis of neonatal bacterial meningitis in infants with different gestational ages and different onsets. Methods Ninety neonates with bacterial meningitis were retrospectively analyzed. According to different gestational ages and times of onset they were divided into 2 groups. The length of hospitalization,cost of hospitalization,duration of antibiotic,NBNA scores,hearing screening results,cranial CT or MRI results,amplitude integrated EEG,outcomes of discharge hospital were compared. Results( 1) Ninety patients diagnosed with bacterial meningitis were divided into preterm group( Group 1,n = 41) and term group( Group 2,n = 49). There were 68. 29% males in Group 1,while 46. 94% in Group 2,with significant difference between them( P = 0. 042). The time of onset of bacterial meningitis of Group 1 was significantly later than that of Group 2 [16. 0( 6. 5,31. 0) d vs. 7. 0( 1. 5,12. 0) d,P < 0. 001]. The length of hospitalization of Group 1 was significantly longer than that of Group 2 [( 53. 41 ± 28. 50) d vs.( 25. 53 ± 13. 27) d,P < 0. 001]. The radio of NBNA score abnormalities of Group 1was significantly lower than that of Group 2( 57. 14% vs 81. 82%,P = 0. 035). There were 33 cured and 1 death in Group 1,while 28 cured and 4 deaths in Group 2,the difference was statistically significant( P < 0. 017).( 2) Ninety patients diagnosed with bacterial meningitis were divided into early-onset group( n = 23) and late-onset group( n =67). The radio of NBNA score abnormalities of early-onset group was significantly higher than that of late-onset group( 89. 47% vs. 61. 90%,P < 0. 001). There was no statistically significant difference in gestational age,length of hospitalization,the average daily cost of hospitalization,the ratio of cranial CT or MRI abnormalities,a EEG abnormalities,optoacoustic emissions screening,auditory evoked potential screening or status on leaving hospital between the two groups.Conclusion Compared with term infant,the preterm infant with bacterial meningitis have a higher ratio on male,later time of onset,longer length of hospitalization,but lower radio of NBNA score abnormalities,higher radio of cure,lower mortality. Compared with the late-onset cases,there is a higher radio of NBNA score abnormalities in early-onset cases.
Objective To analyze the hospitalization and short-term prognosis of neonatal bacterial meningitis in infants with different gestational ages and different onsets. Methods Ninety neonates with bacterial meningitis were retrospectively analyzed. According to different gestational ages and times of onset they were divided into 2 groups. The length of hospitalization,cost of hospitalization,duration of antibiotic,NBNA scores,hearing screening results,cranial CT or MRI results,amplitude integrated EEG,outcomes of discharge hospital were compared. Results( 1) Ninety patients diagnosed with bacterial meningitis were divided into preterm group( Group 1,n = 41) and term group( Group 2,n = 49). There were 68. 29% males in Group 1,while 46. 94% in Group 2,with significant difference between them( P = 0. 042). The time of onset of bacterial meningitis of Group 1 was significantly later than that of Group 2 [16. 0( 6. 5,31. 0) d vs. 7. 0( 1. 5,12. 0) d,P < 0. 001]. The length of hospitalization of Group 1 was significantly longer than that of Group 2 [( 53. 41 ± 28. 50) d vs.( 25. 53 ± 13. 27) d,P < 0. 001]. The radio of NBNA score abnormalities of Group 1was significantly lower than that of Group 2( 57. 14% vs 81. 82%,P = 0. 035). There were 33 cured and 1 death in Group 1,while 28 cured and 4 deaths in Group 2,the difference was statistically significant( P < 0. 017).( 2) Ninety patients diagnosed with bacterial meningitis were divided into early-onset group( n = 23) and late-onset group( n =67). The radio of NBNA score abnormalities of early-onset group was significantly higher than that of late-onset group( 89. 47% vs. 61. 90%,P < 0. 001). There was no statistically significant difference in gestational age,length of hospitalization,the average daily cost of hospitalization,the ratio of cranial CT or MRI abnormalities,a EEG abnormalities,optoacoustic emissions screening,auditory evoked potential screening or status on leaving hospital between the two groups.Conclusion Compared with term infant,the preterm infant with bacterial meningitis have a higher ratio on male,later time of onset,longer length of hospitalization,but lower radio of NBNA score abnormalities,higher radio of cure,lower mortality. Compared with the late-onset cases,there is a higher radio of NBNA score abnormalities in early-onset cases.
引文
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[2] Heath PT,Okike IO. Neonatal bacterial meningitis:an update[J]. Paediatr Child Health,2010,20(11):526-530.
[3]新生儿细菌性脑膜炎研究协作组.中国北方13家医院新生儿化脓性脑膜炎临床与病原特征的多中心研究[J].中华新生儿科杂志,2017,32(6):415-419.
[4]新生儿细菌性脑膜炎多中心研究协作组.华南部分地区新生儿细菌性脑膜炎多中心流行病学研究[J].中华儿科杂志,2018,56(6):421-428.
[5] Ouchenir L,Renaud C,Khan S,et al. The Epidemiology,Management,and Outcomes of Bacterial Meningitis in Infants[J]. Pediatrics,2017,140(1):e20170476.
[6] Okike IO,Johnson AP,Henderson KL,et al. Incidence,etiology,and outcome of bacterial meningitis in infants aged <90 days in the United kingdom and republic of ireland:prospective,enhanced,national population-based surveillance[J]. Clin Infect Dis,2014,59(10):e150.
[7]赵智,华雪莹,张海波,等.新生儿化脓性脑膜炎诊疗现状和预后的多中心调查研究[J].中国新生儿科杂志,2018,33(1):2-6.
[8] Kamoun F,Dowlut MB,Ameur SB,et al. Neonatal purulent meningitis in southern Tunisia:Epidemiology,bacteriology,risk factors and prognosis[J]. Fetal Pediatr Pathol,2015,34(4):233-240.
[9]陈妍,王治平.新生儿脑电图背景活动在判断神经发育预后中的作用[J].国际儿科学杂志,2006,33(1):61-64.
[10]陈敏霞,周伟,唐娟,等.不同病原所致新生儿细菌性脑膜炎急性期脑功能评估[J].中华实用儿科临床杂志,2016,31(12):915-918.
[2] Heath PT,Okike IO. Neonatal bacterial meningitis:an update[J]. Paediatr Child Health,2010,20(11):526-530.
[3]新生儿细菌性脑膜炎研究协作组.中国北方13家医院新生儿化脓性脑膜炎临床与病原特征的多中心研究[J].中华新生儿科杂志,2017,32(6):415-419.
[4]新生儿细菌性脑膜炎多中心研究协作组.华南部分地区新生儿细菌性脑膜炎多中心流行病学研究[J].中华儿科杂志,2018,56(6):421-428.
[5] Ouchenir L,Renaud C,Khan S,et al. The Epidemiology,Management,and Outcomes of Bacterial Meningitis in Infants[J]. Pediatrics,2017,140(1):e20170476.
[6] Okike IO,Johnson AP,Henderson KL,et al. Incidence,etiology,and outcome of bacterial meningitis in infants aged <90 days in the United kingdom and republic of ireland:prospective,enhanced,national population-based surveillance[J]. Clin Infect Dis,2014,59(10):e150.
[7]赵智,华雪莹,张海波,等.新生儿化脓性脑膜炎诊疗现状和预后的多中心调查研究[J].中国新生儿科杂志,2018,33(1):2-6.
[8] Kamoun F,Dowlut MB,Ameur SB,et al. Neonatal purulent meningitis in southern Tunisia:Epidemiology,bacteriology,risk factors and prognosis[J]. Fetal Pediatr Pathol,2015,34(4):233-240.
[9]陈妍,王治平.新生儿脑电图背景活动在判断神经发育预后中的作用[J].国际儿科学杂志,2006,33(1):61-64.
[10]陈敏霞,周伟,唐娟,等.不同病原所致新生儿细菌性脑膜炎急性期脑功能评估[J].中华实用儿科临床杂志,2016,31(12):915-918.