de Louvois John, Halket Susan, Harvey David
Department of Paediatrics, Imperial College School of Medicine, Hammersmith Hospital, London, UK.
Eur J Pediatr. 2005 Dec;164(12):730-4. doi: 10.1007/s00431-005-1747-3. Epub 2005 Sep 1.
This study determined the prevalence of serious sequelae among a national cohort of 5-year old children, born in England and Wales in 1996-7, who had had neonatal meningitis. The results were compared with those from two matched control groups. In addition the results from this study were compared with those from a previous 5-year follow-up of children who had had neonatal meningitis in 1985-7. Follow-up questionnaires requesting information about the children's health and development were sent to the general practitioners (GPs) and parents of the index children and controls. Information was collected on 166 of 232 (72%) children who had had meningitis as neonates, 109 general practice controls and 191 hospital controls. At 5 years, 39/166 (23%) index children had a serious disability compared to 2% of GP controls and 7% of hospital controls. There was a 16-fold increase in risk of serious disability compared to GP-matched controls and a 4-fold increase in risk compared to hospital controls. The isolation of bacteria from the CSF was the best single predictor of serious long-term disability. Although there was a 70% fall in acute phase mortality between 1985 (22%) and 1996 (6.6%), the overall incidence of serious disability remained alarmingly high, 25.5% in 1985 compared to 23.5% in 1996. In the present study, however, fewer children had cerebral palsy or seizure disorders.
Despite the dramatic improvement in acute phase survival following neonatal meningitis, the prevalence of serious sequelae remains alarmingly high.
本研究确定了1996 - 1997年在英格兰和威尔士出生、患有新生儿脑膜炎的5岁儿童全国队列中严重后遗症的患病率。将结果与两个匹配对照组的结果进行了比较。此外，还将本研究的结果与之前对1985 - 1987年患有新生儿脑膜炎的儿童进行的5年随访结果进行了比较。向病例儿童和对照儿童的全科医生（GP）及家长发送了随访问卷，询问有关儿童健康和发育的信息。收集了232名新生儿期患脑膜炎儿童中的166名（72%）、109名全科医疗对照儿童和191名医院对照儿童的信息。5岁时，166名病例儿童中有39名（23%）有严重残疾，而全科医疗对照儿童中有2%，医院对照儿童中有7%有严重残疾。与全科医疗匹配对照相比，严重残疾风险增加了16倍，与医院对照相比，风险增加了4倍。脑脊液中细菌的分离是严重长期残疾的最佳单一预测指标。尽管1985年（22%）至1996年（6.6%）急性期死亡率下降了70%，但严重残疾的总体发生率仍然高得惊人，1985年为25.%, 1996年为23.5%。然而，在本研究中，患脑瘫或癫痫障碍的儿童较少。
尽管新生儿脑膜炎急性期存活率有显著提高，但严重后遗症的患病率仍然高得惊人。
