What Is Neonatal Meningitis?

Neonatal purulent meningitis refers to meningitis caused by pyogenic bacteria within 4 weeks after birth, which is a common life-threatening disease. This disease is usually part of or secondary to sepsis, and 25% of neonatal sepsis Will be complicated by purulent meningitis. The incidence rate is about 0.2 to 1 of live births, and up to 3 of premature babies. The clinical symptoms are often atypical (especially in premature babies). The signs of increased intracranial pressure are relatively late, and the meningeal irritation is often lacking. Therefore, early diagnosis is difficult. Therefore, when purulent meningitis is suspected, early examination of the cerebrospinal fluid should be made early. Thorough treatment reduces mortality and sequelae.

Basic Information

English name

neonatal purulent meningitis

Visiting department

Neonatal, Neurology

Multiple groups

premature baby

Common causes

Often part of or secondary to sepsis

Common symptoms

Clinical symptoms are often atypical, and signs of increased intracranial pressure appear later

Contagious

Causes of neonatal purulent meningitis

The disease is often part of or secondary to sepsis. It is generally believed that the pathogenic bacteria of purulent meningitis are the same as sepsis, but this is not completely the case, because some meningitis may be free of sepsis, and the pathogenic bacteria directly invade the meninges or only transient bacteria. Bloodemia. There are B-group hemolytic streptococci, Escherichia coli, Listeria, Klebsiella, Salmonella, denaturing bacteria, etc. in foreign countries, but the domestic pathogens vary from place to place, including Escherichia coli, Staphylococcus, Acinetobacter, Proteus and so on. The infection route of this disease:

Prenatal infection

Extremely rare. When the mother has Listeria infection with bacteremia, the bacteria can cause miscarriage, stillbirth, and premature delivery through the placenta. Pyogenic meningitis can even become part of the fetal systemic infection.

2. Infection at birth

Most patients have a history of premature rupture of the membranes, prolonged labor, and dystocia. The pathogenic bacteria can contaminate the amniotic fluid from the mother's rectum or vagina or the fetus inhales or swallows when passing through the birth canal.

3. Postnatal infection

Pathogens can invade the blood circulation from the respiratory tract, umbilicus, damaged skin and mucous membranes, digestive tract, and binding membranes to the meninges. Neonates with otitis media, infectious skull hematoma, cranial fracture, spina bifida, meningocele, skin sinus tract (a few are in communication with the subarachnoid space), most of the pathogens directly invade the meninges and cause meningitis.

Clinical manifestations of neonatal purulent meningitis

General performance

Clinical manifestations are often atypical, especially in premature babies, including poor mental and complexion, low response, less crying and less movement, decreased breast rejection or breastfeeding, vomiting, fever, or hypothermia, jaundice, liver enlargement, abdominal distension, shock, etc. .

2. Special performance

Elevated intracranial pressure such as vomiting, anterior condylar bulge, or fullness appears late or inconspicuous, and neck stiffness is rare.

(1) Consciousness: irritability, irritability, startle, sudden screaming, lethargy, and allergies.

(2) Eye abnormalities: eyes are apathetic, eyes stare, strabismus, and the eyeballs are turned up or down in the setting sun, nystagmus, and the pupils' reflection of light is slow or different in size.

(3) Convulsions: eyelid twitches, small facial twitches such as sucking, paroxysmal bruising, apnea, and side or local limb tics.

(4) Increased intracranial pressure: Tension, fullness or bulge of the anterior crest is a late manifestation, and anterior cranial level also indicates increased intracranial pressure when dehydration occurs.

Neonatal purulent meningitis

Laboratory inspection

(1) Peripheral blood image: white blood cell count and neutrophil count increased. In severe cases, the white blood cell count decreased below 4 × 10 / L, and the platelet count decreased.

(2) Bacterial culture: blood culture and bacterial culture of lesion secretions, the positive rate of blood culture can reach 45% to 85%, especially for those with early-onset sepsis and early disease without antibiotic treatment, urine culture and lesion secretion Cultures can sometimes be positive.

(3) Cerebrospinal fluid examination: For those with suspected meningitis, a lumbar puncture should be performed immediately, and the pressure of the cerebrospinal fluid should be measured with a pressure tube, and the cerebrospinal fluid should be taken for examination: the pressure is often> 3 to 8 cmH ₂ O, the appearance is unclear or cloudy, apply The film can find bacteria, protein. Full-term infants> 0.1 to 1.7 g / L, preterm infants> 0.65 to 1.5 g / L. The number of white blood cells is> 10 30 × 10 / L, and the classification is mainly multinucleated or monocytes. Reduced glucose and increased lactate dehydrogenase. Positive culture.

2. Other auxiliary inspections

(1) Cranial radiograph, skull B-ultrasound and CT: Examination of skull radiograph, skull B-ultrasound and CT can help diagnose ventricular inflammation, subdural effusion, brain abscess, hydrocephalus, etc.

(2) Radionuclide brain scan: valuable for multiple brain abscesses.

(3) Magnetic resonance imaging (MRI): Great value for multi-atrial and multiple small abscesses.

Diagnosis of purulent meningitis in newborns

A clear diagnosis can be made based on the child's medical history and the above examinations.

Neonatal purulent meningitis complications

The clinical efficacy is not good, or the cerebrospinal fluid examination improves during treatment and the body temperature continues to decline, and the clinical symptoms do not disappear. After the condition improves, high fever, convulsions, vomiting, fullness or bulge of the anterior palate should be considered.

Subdural effusion

The subdural fluid is more than 2ml, and the protein is greater than 0.6g / L, and the red blood cells are less than 100 × 10 / L, which can be diagnosed.

2. ventricular meningitis

Its incidence can reach 65% to 90%, or even 100%. The younger the person and the more delayed the diagnosis and treatment of purulent meningitis, the higher the incidence. Examination of the lateral ventricle puncture revealed abnormalities.

Treatment of neonatal purulent meningitis

Antibiotic treatment

As early as possible, large doses, foot courses, easy to be treated with blood-brain barrier antibiotics. When the pathogen is not clear, antibiotics can be selected according to the situation of recent pathogens in the area. Once the pathogen is clear, antibiotics should be selected according to drug sensitivity tests.

2. Complications treatment

(1) Subdural effusion: A small amount of effusion does not need to be treated. If the intracranial pressure is increased due to a large amount of fluid, a subdural puncture should be performed to release the fluid. Some children need to be punctured repeatedly, and most of the children's effusion is gradually reduced and cured. Individuals who do not heal need surgical drainage.

(2) Ventricular meningitis: lateral ventricular puncture and drainage to relieve symptoms. At the same time, according to the pathogenic bacteria and the safety of medication, appropriate antibiotics were injected intraventricularly, but the curative effect is not exact and should be avoided as much as possible.

3. Symptomatic and supportive treatment

(1) Closely monitor vital signs, regularly observe changes in children's consciousness, pupils and breathing rhythm, and deal with intracranial hypertension in time.

(2) Control seizures in time, infusion of fresh plasma, blood or gamma globulin.

(3) Monitor and maintain water, electrolyte, plasma osmotic pressure and acid-base balance in the body. For those with abnormal antidiuretic hormone secretion syndrome, while actively controlling meningitis, appropriately limit the amount of fluid, and add sodium salt as appropriate for those with severe symptoms of hyponatremia.

(4) The application of adrenal glucocorticoids in critically ill children is still controversial. For long-term fever, high cerebrospinal fluid protein, turbid appearance, etc., it can be applied in small doses for short-term to relieve the condition.

Prognosis of neonatal purulent meningitis

Early diagnosis and timely and correct treatment are the keys to success. If timely diagnosis and proper treatment can be obtained as soon as possible, neonatal purulent meningitis can be completely cured, and it will play a decisive role in reducing sequelae. The mortality rate of the disease has not decreased significantly in recent years. General data show that it can reach 12% to 30%, low weight infants and premature babies can reach 50% to 60%, and survivors may have hearing loss, blindness, epilepsy, and hydrocephalus. , Intellectual and / or dyskinetic sequelae.

Prevention of neonatal purulent meningitis

Prevention is focused on preventing bacteria from invading the body and spreading to the brain, such as preventing respiratory, gastrointestinal and skin infections, treating sinusitis, otitis media, and neonatal umbilical infections in a timely manner. Local infections should be treated as soon as possible. Pay attention to disinfection and isolation.