Skjellegrind Karin, Bergseng Håkon
Tidsskr Nor Laegeforen. 2019 Nov 4;139(16). doi: 10.4045/tidsskr.18.0861. Print 2019 Nov 5.
Nowadays severe illness in neonates is fortunately rare in Norway. However, newborns present with non-specific symptoms, making diagnostics in this age group challenging, and neonatologists need to think broadly in order not to overlook serious illness. We present the case of a nine-day-old who was severely ill when she arrived at hospital. She was born in gestational week 37 after a normal pregnancy. The birth was complicated by shoulder dystocia, rupture of the umbilical cord and fracture of the clavicle. Thereafter she had a normal stay in the maternity ward for three days. At home she appeared healthy and gained weight until she returned to hospital after thirteen hours of poor feeding, irritability and fever. The symptoms turned out to be caused by bacterial meningitis. During the first week of hospitalisation she developed ventriculitis, brain abscesses and sinus vein thrombosis. It was later discovered that she had severely impaired hearing, and thereafter she developed hydrocephalus requiring surgical drainage. The mortality from neonatal bacterial meningitis has dropped from almost 50 % in the 1970s to less than 10 % today, but the morbidity has remained unchanged. It is crucial that clinicians are alert to this diagnosis, as delayed treatment can worsen the prognosis.
如今在挪威，新生儿重症幸好较为罕见。然而，新生儿出现的症状不具特异性，这使得该年龄组的诊断颇具挑战性，新生儿科医生需要全面思考，以免忽视严重疾病。我们介绍一例9天大的患儿，入院时病情严重。她在孕期37周时经正常妊娠出生。分娩过程因肩难产、脐带破裂和锁骨骨折而复杂化。此后，她在产科病房正常度过了三天。在家时她看起来健康且体重增加，直到在出现喂养不佳、烦躁和发热13小时后再次入院。结果发现这些症状是由细菌性脑膜炎引起的。在住院的第一周，她发展为脑室炎、脑脓肿和窦静脉血栓形成。后来发现她听力严重受损，此后又患上了需要手术引流的脑积水。新生儿细菌性脑膜炎的死亡率已从20世纪70年代的近50%降至如今的不到10%，但发病率仍未改变。临床医生对这一诊断保持警惕至关重要，因为延迟治疗会使预后恶化。
