Objective:

Hydrocephalus is a potentially lethal complication of neonatal purulent meningitis. Early detection of hydrocephalus helps to determine optimal treatment, improve prognosis, and reduce financial burden. We aimed to analyze the risk factors for hydrocephalus in neonates with purulent meningitis and discuss the characteristics of the disease.

Methods:

The records of neonatal purulent meningitis admitted to the Children Hospital of Fudan University from January 2013 to September 2019 were retrospectively included in the study cohort. The data of clinical, laboratory, and cranial magnetic resonance images (MRIs) were collected and analyzed (except discharge data) by univariate analysis, and P values <.05 were further analyzed by multivariate logistic regression.

Results:

A total of 197 children who met the inclusion criteria were enrolled in the study cohort. Overall, 39.6% (78/197) of the patients had positive pathogen cultures, and 60.4% (119/197) of patients had clinical diagnosis of meningitis with negative pathogen cultures. Among 197 children, 67 of them experienced hydrocephalus, and the factors that were significantly associated with hydrocephalus in multivariate analysis were female sex, cerebrospinal fluid glucose <2 mmol/L, periventricular leukomalacia, punctate white matter lesions, and pyogenic intraventricular empyema. Children with hydrocephalus had a lower cure rate of meningitis (31.3% vs 75.4%), and poor discharge outcomes. In addition, they had longer length of hospital stay and higher hospital cost.

Conclusions:

Female sex, cerebrospinal fluid glucose <2 mmol/L, periventricular leukomalacia, punctate white matter lesions, and pyogenic intraventricular empyema were identified as risk factors for hydrocephalus in neonatal purulent meningitis. Children with hydrocephalus had poor discharge outcomes and increased financial burden on their families.

中文翻译：

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新生儿化脓性脑膜炎脑积水的危险因素：单中心回顾性分析

客观的：

脑积水是新生儿化脓性脑膜炎的潜在致命并发症。早期发现脑积水有助于确定最佳治疗方案、改善预后并减轻经济负担。我们旨在分析新生儿化脓性脑膜炎脑积水的危险因素，并讨论该病的特点。

方法：

回顾性纳入复旦大学儿童医院2013年1月至2019年9月收治的新生儿化脓性脑膜炎病历。通过单变量分析收集和分析临床、实验室和颅脑磁共振图像（MRI）数据（出院数据除外），并通过多变量logistic回归进一步分析P值<.05。

结果：

共有 197 名符合纳入标准的儿童被纳入研究队列。总体而言，39.6% (78/197) 的患者病原体培养阳性，60.4% (119/197) 的患者临床诊断为脑膜炎，病原体培养阴性。197名儿童中，67人出现脑积水，多因素分析与脑积水显着相关的因素为女性、脑脊液葡萄糖<2 mmol/L、脑室周围白质软化、点状白质病变、化脓性脑室内积脓。脑积水儿童的脑膜炎治愈率较低（31.3% vs 75.4%），出院结果较差。此外，他们的住院时间更长，住院费用更高。

结论：

女性、脑脊液葡萄糖<2 mmol/L、脑室周围白质软化、点状白质病变和化脓性脑室内积脓被确定为新生儿化脓性脑膜炎脑积水的危险因素。患有脑积水的儿童出院结果不佳，增加了家庭的经济负担。