Long-term prognosis and related factors of neonatal and small infants meningitis caused by streptococcus agalactiae

Abstract

Objective: To explore the long-term prognosis and related factors of neonates and infants meningitis caused by Streptococcus agalactiae. Methods: The Clinical data of neonates and small infants with Streptococcus agalactiae meningitis admitted to the Children's Hospital of Zhengzhou University from January 2015 to May 2022 were retrospectively collected, and long-term follow-up of neurological development was conducted for the patients, with a follow-up period of ≥18 months. According to long-term neurological prognosis indicators, the patients were divided into good prognosis group and poor prognosis group, and the multivariate logistic regression model was used to analyze the factors affecting the long-term prognosis of the patients. Results: A total of 86 children were included, with 50 males and 36 females, and their age ranged from 3 to 85 (29.7±18.5) days. The follow-up duration was 20 to 78(47.2±17.0) months, and the age at the end of follow-up was 1.8 to 6.6(4.2±1.3) years. Among them, there were 54 cases in good long-term prognosis group and 32 cases in poor prognosis guoup. Infectious shock [56.3%(18/32) vs 13.0%(7/54), P<0.001], hypoproteinemia [46.9%(15/32) vs 22.2%(12/54), P=0.017], surgical intervention for neurological complications [31.0%(13/32) vs 7.4%(4/54), P=0.003], abnormal neurological examination at discharge [37.5%(12/32) vs 7.4%(4/54), P<0.001], and abnormal cranial imaging at discharge [53.1%(13/32) vs 7.4%(4/54), P<0.001] were higher in the poor prognosis group than those in the good prognosis group. The peripheral blood WBC count [M(Q1, Q3)] [4.7(3.4, 7.6)]×109/L at the onset of the disease was lower in the poor prognosis group than that in the good prognosis group [10.1(3.8, 14.1)]×109/L, and the cerebrospinal fluid protein concentration [3.0(2.1, 3.8)] g/L was higher in the poor prognosis group than that in the good prognosis group [2.5(1.9, 2.8)] g/L (both P<0.05). The multivariate logistic regression model found that peripheral blood WBC<4.0×109/L (OR=5.501,95%CI:1.430-21.170,P=0.013), infectious shock (OR=4.600,95%CI:1.008-21.004,P=0.047), neurological complications undergoing surgical intervention (OR=8.961,95%CI:1.792-44.812,P=0.008), and abnormal head imaging at discharge (OR=12.636,95%CI:2.502-63.829,P=0.002) were related factors for poor long-term prognosis in neonatal and infants meningitis caused by Streptococcus agalactiae. Conclusions: Neonates and infants meningitis caused by Streptococcus agalactiae have a high incidence of long-term adverse prognosis. Peripheral blood WBC<4.0×109/L, infectious shock, neurological complications undergoing surgical intervention, and abnormal cranial imaging at discharge are related factors for poor long-term prognosis.