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.
目的： 探讨新生儿及小婴儿无乳链球菌脑膜炎远期预后及相关因素。 方法： 回顾性收集2015年1月至2022年5月郑州大学附属儿童医院收治的新生儿及小婴儿中无乳链球菌脑膜炎患儿临床资料，并对患儿进行神经系统发育长期随访，随访时间≥18个月。根据远期神经系统预后指标分为预后良好组和预后不良组，采用多因素logistic回归模型分析影响患儿远期预后的相关因素。 结果： 共纳入患儿86例，男50例，女36例，年龄3~85（29.7±18.5）d。随访时间20~78（47.2±17.0）个月，患儿随访结束时年龄为1.8~6.6（4.2±1.3）岁，其中远期预后良好组54例，预后不良组32例。预后不良组的感染性休克［56.3%（18/32）比13.0%（7/54），P<0.001］、合并低蛋白血症［46.9%（15/32）比22.2%（12/54），P=0.017］、神经系统并发症接受手术干预［31.0%（13/32）比7.4%（4/54），P=0.003］、出院时神经系统检查异常［37.5%（12/32）比7.4%（4/54），P<0.001］、出院时头颅影像学仍异常［53.1%（13/32）比7.4%（4/54），P<0.001］的发生率均高于预后良好组；预后不良组起病时外周血白细胞计数［M（Q1，Q3）］［4.7（3.4，7.6）］×109/L低于预后良好组［10.1（3.8，14.1）］×109/L，预后不良组脑脊液蛋白质浓度［3.0（2.1，3.8）］g/L高于预后良好组［2.5（1.9，2.8）］g/L（均P<0.05）。多因素logistic回归模型分析发现，外周血白细胞<4.0×109/L（OR=5.501，95%CI：1.430~21.170，P=0.013）、感染性休克（OR=4.600，95%CI：1.008~21.004，P=0.047）、神经系统并发症接受手术干预（OR=8.961，95%CI：1.792~44.812，P=0.008）和出院时头颅影像学仍异常（OR=12.636，95%CI：2.502~63.829，P=0.002）是新生儿及小婴儿无乳链球菌脑膜炎远期神经预后不良的相关因素。 结论： 新生儿及小婴儿无乳链球菌脑膜炎远期不良预后发生率高，外周血白细胞<4.0×109/L、感染性休克、神经系统并发症接受手术干预和出院时头颅影像学仍异常是远期预后不良的相关因素。.