Cerebral function assessment in the acute phase of neonatal bacterial meningitis caused by different pathogens

Abstract

Objective To investigate the common pathogens of neonatal bacterial meningitis in the past 5 years, and to evaluate the brain injury in the acute phase through amplitude-integrated electroencephalogram (aEEG), brainstem auditory evoked potential (BAEP) and brain MRI. Methods Sixty children were selected from the past 5 years who were treated in Department of Neonatology, Guangzhou Women and Children's Medical Center in March 2011 to March 2015 as the objects of study.According to the results of etiological culture, the children were divided into streptococcus lactis group (14 cases), escherichia coli group (10 cases), other positive bacteria group (11 cases) and culture-negative group (25 cases). The results of aEEG, BAEP and brain MRI of brain injury in the acute phase of these 4 groups were compared. Results Twenty-nine cases of the 60 patients (48.3%) showed positive blood culture, and 14 cases (23.3%) showed positive cerebrospinal fluid(CSF) culture.Streptococcus lactics and escherichia coli were found to be the most common pathogens that caused neonatal bacterial meningitis.By evaluating the cerebral function in the acute phase of 57 cases, it was found that aEEG total abnormal rate was 61.4%, escherichia coli group abnormal rate was 80.0%, while moderate to severe damage seemed to be the most remarkable feature.The abnormal rate was of statistical significance between escherichia coli group and culture-negative group(χ2=3.941, P=0.047). Forty-eight cases manifested potential anomaly evoked by brainstem auditory, with the total abnormal rate as 84.2%.A significant increase in the ratio of severe hearing loss was found in children with bacterial meningitis which was caused by escherichia coli and streptococcus agalactiae.The abnormal rate was of statistical significance between escherichia coli group and culture-negative group (χ2=4.399, P=0.036), and hearing damage caused by escherichia coli was more serious than that in other bacteria group.Of these 57 cases, MRI total abnormal rate was 77.2%, with hydrocephalus as the most common complication.Of the 44 abnormal cases, 16 cases showed hydrocep-halus, 6 cases of which were from the escherichia coli group.The second most common complication was subdural effusion.And another 5 cases showed cerebral softening, 3 cases of which were from the escherichia coli group.The data suggested that escherichia coli meningitis easily combined hydrocephalus and brain softening. Conclusions The main pathogens of neonatal bacterial meningitis is streptococcus agalactiae and escherichia coli.The brain injury in neonatal bacterial meningitis caused by escherichia coli is more serious than those caused by other pathogens. Key words: Bacterial meningitis; Pathogens; Amplitude-integrated electroencephalogram; Brainstem auditory evoked potential; Electroencephalogram; Infant, newborn