Comparative study on the clinical features of purulent meningitis in preterm and term infants: a clinical analysis based on 10 years

Abstract

Objective To study the differences of clinical manifestations, etiology and hospitalized outcomes of purulent meningitis in preterm and term infants. Method All preterm and term infants with purulent meningitis hospitalized in the Hospital from 2006 to 2015 were enrolled in this study. The data of neonate′s condition, maternal condition, clinical manifestations, complications, etiology, treatment and outcomes of the preterm and term infants groups were compared. Result During the study period, 44 preterm infants and 118 term infants were included. The time of onset for purulent meningitis of preterm infants group was statistically earlier than that of term infants group [11.2 (3.2, 19.8) d vs. 14.3 (5.6, 23.9) d, P<0.05]. The prognosis of preterm infants group was statistically worse than that of term infants group (P<0.05). Among them, the incidences of clinical manifestations in preterm infants group compared to term infants group were: fever (54.5% vs. 78.8%), seizure (11.4% vs. 26.3%), lethargy and poor response (59.1% vs. 38.1%), slow weight gain (9.1% vs. 0%), apnea (45.5% vs. 0.8%) and cyanosis (15.9% vs. 4.2%); all the differences between two groups were significant (P<0.05). The time of onset for purulent meningitis with complications was statistically earlier than those without complications [9.5 (4.1, 20.5) d vs. 13.8 (5.9, 22.0) d, P<0.05]. The duration of treatment for purulent meningitis with complications was longer than that without complications [(42.2±8.8) d vs. (28.7±7.1) d, P<0.05], and the positive rate of pathogens was also statistically higher than those without complications (73.8% vs. 26.7%, P<0.05). Coagulase-negative staphylococcus was the main pathogen for both preterm and term infants group. Klebsiella pneumoniae was more common in preterm infants group than in term infants group (40.0% vs. 10.4%, P<0.05). Conclusion Preterm infants with purulent meningitis had early onset time, atypical clinical manifestations, and poor prognosis. The treatment course for purulent meningitis with complications is prolonged. The pathogens for neonatal purulent meningitis have already changed. The detection rate of conditional pathogens is increasing yearly, for which the clinicians should take note seriously. Key words: Meningitis, bacterial; Clinical research; Noxae; Infant, premature