关键词: 不典型化脓性脑膜炎, 脑脊液, 早期诊断治疗, 后遗症, 婴儿, 新生

Abstract:
Objective
To investigate the clinical methods for early diagnosis and treatment of atypical neonatal purulent meningitis and summarize the clinical experience.
Methods
A total of 60 cases of children with atypical neonatal purulent meningitis were included, who were hospitalized in our Neonatal Department from January 2011 to June 2016. Collect the children's information, including general demographic information, clinical manifestation and the laboratory examination data.  Intravenous injection of ceftriaxone sodium(brand name: Rocephin) was given, 50 mg/kg/time, twice a day, to the clearly diagnosed cases, which lasted 3 to 4 weeks.
Results
The children's clinical manifestations when hospitalized were as follows: fever in 60 cases; somnolence and irritation in 39 cases; piebaldskin in 41 cases; full bregma in 27 cases; bregma nervous in 27 cases; high muscular tension in 32 cases; low muscular tension in 19 cases; no symptom of convulsions, screaming, milk rejecting, staring or respiratory failure. After treatment, the symptoms of fever, irritation and piebaldskin in all the patients disappeared. Bregma became flat and soft, muscular tension returned normal, and the symptom was relived. After Rocephin treatment, white blood cell count, neutrophil, M% & content of C-reactive protein, CSF white blood cell count, and protein content were lower than those before treatment, and the difference was statistically significant(P<0.05). Positive rate of Pandys test, blood culture and CSF culture was lower than the rate before treatment and there is statistically significant difference(P<0.05). Brain MRI indicated abnormal in 11 cases, including enlargement of subarachnoid spaces in 11 cases, hydrocephalus in 8 cases, subdural effusion in 1 case, and hydrocephalus with Ependymitis in 1 case. The rate of sequelae was 18.3% (11/60).
Conclusion
Fever, somnolence and irritation are the important manifestations of atypical neonatal purulent meningitis in early stage. Piebaldskin, full bregma and nervous, and dystonia are the vital signs. Providing timely CSFexamination at hospitalization can help the early diagnosis of purulent meningitis, and the disease can be controlled as soon as possible with Rocephin treatment, which also prevents convulsion and other cerebral edema, reducing the incidence of sequelae and death.

Key words: Atypical purulent meningitis, Cerebrospinal fluid(CSF), Early diagnosis and treatment, Sequelae, Infant,newborn