title: [Clinical analysis and follow-up of neonatal purulent meningitis caused by group B streptococcus].
abstract: OBJECTIVE
  To study the clinical characteristics, antibiotics sensitivity and outcome of group B streptococcus (GBS) meningitis in neonates in order to provide the guide for early diagnosis and appropriate treatment.
  
  
  METHODS
  A retrospective review was performed and a total of 13 cases of neonatal purulent meningitis caused by GBS were identified in the Neonatal Intensive Care Unit of Yuying Children's Hospital of Wenzhou Medical University from January 1, 2005 to May 31, 2013. The clinical characteristics, antibiotics sensitivity test results and outcome were analyzed.
  
  
  RESULTS
  Fever, poor feeding, seizure and lethargy were common clinical signs of neonatal purulent meningitis caused by GBS. Three cases of early onset GBS meningitis received prepartum antibiotics. All 13 cases had abnormal C-reactive protein (CRP) level, and 11 cases had increased CRP within hours after admission. Of the 13 patients, 7 were cured, 4 discharged with improvement, 2 patients died during hospitalization after being given up because of serious complication. The average length of stay for recovered patients was (47 ± 21)d. Acute complications mainly included hyponatremia (5 cases), intracranial hemorrhage (3 cases) , ventriculomegaly (3 cases) , subdural collection (2 cases) , hydrocephalus (2 cases), septic shock (2 cases), cerebral hernia (1 case), encephalomalacia (1 case). One preterm patient with early onset GBS meningitis died 1 month after hospital discharge. Among 7 survivors with 10-24 months follow-up, 3 were early onset GBS meningitis, 2 with normal results of neurologic examination, 1 with delayed motor development, 4 were late onset GBS meningitis, 1 with normal results of neurologic examination, 3 were neurologically impaired with manifestations including delayed motor development (2 cases) and seizures (1 case). All the GBS strains were sensitive to penicillin and linezolid (13/13, 10/10), the susceptibility to levofloxacin, ampicillin and vancomycin were 11/12, 9/10, 8/13 respectively.
  
  
  CONCLUSIONS
  The clinical manifestations of neonatal purulent meningitis caused by GBS are usually non-specific. It is associated with long hospitalization, neurological impairments and sequelae. Monitoring of serum CRP level is valuable for early diagnosis. Antepartum prophylaxis, early diagnosis and therapy are vital. Large dose penicillin is the priority choice to treat the neonatal purulent meningitis caused by GBS, linezolid should be used in intractable cases.
authors.affiliation: Department of Neonatology, Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325027, China.
authors.forename: Minli
authors.initials: M
authors.lastname: Zhu
authors.forename: Jianghu
authors.initials: J
authors.lastname: Zhu
authors.forename: Haijing
authors.initials: H
authors.lastname: Li
authors.forename: Peining
authors.initials: P
authors.lastname: Liu
authors.affiliation: Email: Linzhenlang@hotmail.com.
authors.forename: Zhenlang
authors.initials: Z
authors.lastname: Lin
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D002097:C-Reactive Protein / Q000032:analysis; D024881:Drug Resistance, Bacterial; D005260:Female; D005334:Fever / Q000175:diagnosis / Q000188:drug therapy / Q000473:pathology; D005500:Follow-Up Studies; D006801:Humans; D007010:Hyponatremia / Q000209:etiology; D007231:Infant, Newborn; D007958:Leukocyte Count; D008297:Male; D016920:Meningitis, Bacterial / Q000175:diagnosis / Q000188:drug therapy* / Q000473:pathology; D008826:Microbial Sensitivity Tests; D010406:Penicillins / Q000627:therapeutic use; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious; D012189:Retrospective Studies; D013290:Streptococcal Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000473:pathology; D013292:Streptococcus agalactiae
chemical_list: D000900:Anti-Bacterial Agents; D010406:Penicillins; D002097:C-Reactive Protein