Grimwood K, Nolan T M, Bond L, Anderson V A, Catroppa C, Keir E H
Department of Paediatrics, University of Melbourne, Parkville, Victoria, Australia.
J Paediatr Child Health. 1996 Oct;32(5):457-62. doi: 10.1111/j.1440-1754.1996.tb00949.x.
To identify risk factors for adverse outcomes from bacterial meningitis.
From a cohort of 166 children with bacterial meningitis who were studied prospectively, 130/158 (82%) survivors underwent neurological, neuropsychological, audiological and behaviour assessments 5-9 years following their illness.
Major adverse outcomes included B/166 (4.8%) deaths and severe neurological, intellectual or audiological sequelae in 11/130 (8.5%) children followed. Another 24 (18.5%) had cognitive, auditory or behaviour disorders. Bivariate analysis found age < or = 12 months, tertiary referral, symptoms > 24 h before diagnosis, seizures, focal neurological signs, deteriorating conscious state in hospital, Streptococcus pneumoniae infection and serum sodium concentration < 130 mmol/L were associated with adverse outcomes. Multivariate analysis showed age < or = 12 months, symptoms > 24 h, seizures after 72 h in hospital and focal neurological signs as independent risk factors. These were present in 18/19 (95%) children with major sequelae, but absent in 9/24 (37.5%) children with minor disabilities.
As minor disabilities following meningitis cannot be predicted, all survivors require assessment during their early school years.
确定细菌性脑膜炎不良预后的危险因素。
在一组166例接受前瞻性研究的细菌性脑膜炎患儿中，130/158（82%）名幸存者在患病5至9年后接受了神经学、神经心理学、听力学和行为评估。
主要不良预后包括166例中有4.8%（即B例）死亡，以及在接受随访的130例儿童中有11例（8.5%）出现严重的神经、智力或听力学后遗症。另有24例（18.5%）有认知、听觉或行为障碍。双变量分析发现年龄≤12个月、三级转诊、诊断前症状持续>24小时、癫痫发作、局灶性神经体征、住院期间意识状态恶化、肺炎链球菌感染以及血清钠浓度<130 mmol/L与不良预后相关。多变量分析显示年龄≤12个月、症状持续>24小时、住院72小时后癫痫发作以及局灶性神经体征为独立危险因素。这些因素在19例有主要后遗症的儿童中有18例（95%）存在，但在24例有轻度残疾的儿童中有9例（37.5%）不存在。
由于脑膜炎后的轻度残疾无法预测，所有幸存者在其早年上学期间都需要进行评估。
