The first signs of meningitis in a child are the types of diseases, manifestations and treatment. Severe consequences and poor prognosis. Forms and causes of meningitis

REFERENCE! Meningitis in infants occurs in 1 out of 100 children, most often children who are under one year old are affected. Half of the patients die.

The first signs in infants up to a year

During the incubation period of meningitis in infants, there are signs:

headache, pain of a bursting nature;
body temperature rises;
the child is sick and vomits;
the baby is weak, lethargic;
drowsiness;
skin is unnaturally pale;
the body breaks;
intolerance to bright lights and loud sounds;
constant, high-pitched crying.

When the disease begins to develop, the temperature in the infant rises quickly. For 3-4 hours it rises to 40 degrees. With timely measures taken, the temperature drops on the third day.

Headache in the forehead, eyes, nose. At elevated temperatures, nausea and vomiting begin. The cause of vomiting is that the vomiting center of the brain swells. Vomiting is not related to food, the child begins to vomit when he is turned over or the headaches increase.

Symptoms of meningitis in an infant

The child refuses to eat, the respiratory rhythm is changed, he suffers from convulsions. Consciousness is lost, the fontanel is compacted. Fever, poor appetite and vomiting do not yet indicate that this is meningitis. Such signs are characteristic of other diseases. An accurate diagnosis is made if there are the following symptoms of meningitis in infants:

The occipital muscles numb.
Buccal symptom.
Muscles are tense.
The baby lies on its side, head thrown back and knees bent to the stomach.

What to do if there are warning signs of the disease?

If a child under one year old has symptoms of meningitis, an ambulance team is quickly called. Only the doctor knows what measures to take for treatment. You cannot act on your own.

Why is self-medication dangerous?

Alternative methods of treatment are unacceptable. The disease is acute, passes with lightning speed. The immune system of the baby itself is not able to cope with the pathology, self-treatment methods will not bring a positive effect.

Self-medication with medications is also dangerous. There are drugs that are incompatible with other drugs. The dosage of the drug depends on the weight of the child, only the pediatrician determines this accurately. The duration of taking medications is determined by the doctor.

IMPORTANT: incorrectly selected medications lead to disorders of the gastrointestinal tract. The child is sick, problems with a chair, the stomach is swollen.

If you do not start traditional treatment in a timely manner, there are consequences and complications:

excess fluid accumulates in the brain;
intoxication of the body leads to toxic shock;
the brain swells;
hearing deteriorates.

The reasons

The immediate cause of the disease in children at any age is infectious agents. Common:

viruses;
fungi;
bacteria;
toxoplasma (protozoa).

At different ages, different microbial agents influence the development of the disease.. There is a rule:

In newborns, the disease is formed as a result of intrauterine infection. It is passed on to the fetus from the mother. Herpetic or toxoplasma infection.
In infants, meningitis is a sign of congenital syphilis or HIV (combination with other infectious signs).

Risk group:

Important! The main cause of the disease is a weak children's immunity.

Conclusion

To prevent complications, a full treatment course is completed. After all signs of meningitis in infants have disappeared, treatment lasts another 2-3 weeks until complete recovery. Immunomodulators are taken, blood and urine tests are repeated. The risk of relapse is high.

Today, a large number of young patients suffer from infectious diseases. These include meningitis. Symptoms of meningitis in children (pain, fever, and others) are caused by inflammation of the meninges of the brain. The disease does not affect the brain cells, but its outer part. Meningitis has a different nature of origin, provoked by several types of pathogens. To avoid complications, to start treatment of the disease in a timely manner, you need to familiarize yourself with its signs and features in advance.

Types of childhood meningitis by the nature of development:

primary - a separate independent disease with the absence of a local inflammatory process in the organs;
secondary - damage to the meninges is caused by a general or local infectious disease.

The main causes of the development of an inflammatory infection:

One of the main causes of meningitis is an infection in the lining of the brain. It gets inside by airborne, hematogenous, fecal-oral or lymphogenous routes. The infection develops in the child's body with the help of:

bacteria (Escherichia or tubercle bacillus, staphylococcus, streptococcus);
fungi (candida, cryptococcus);
viruses (herpes, mumps).

Weakened immunity due to:

regular hypothermia;
chronic diseases;
diabetes mellitus;
HIV infection;
congenital abnormalities of the immune system.

Signs of meningitis in children

In most cases, the signs of meningitis in children manifest themselves almost the same way in young patients and adults. An unfavorable prognosis appears when parents ignore the manifestations of the disease and therapy is not started on time. Based on medical observations, common clinical signs of meningitis in a child are as follows:

severe weakness, general malaise;
a significant increase in temperature;
loss of consciousness;
vomit;
another sign of meningitis in children is intense pain in the head, joints, muscles;
fever, chills;
loss of appetite;
convulsions;
the appearance of a runny nose, redness of the throat;
rigidity (a sharp increase in muscle tone, their resistance to deformation);
the sick child almost always lies on his side, with his legs tucked in and his head thrown back.

There are also common specific factors that signal the presence of a neuroinfection. Often, the doctor makes a final, accurate diagnosis based on them. Here is how meningitis manifests itself in children:

Neck stiffness. Constant tilting of the child's head due to strong muscle tone.
Kernig's sign. With meningitis, the ability to straighten the lower limb at the knee joint disappears if it is bent at the hip. This symptom of the disease is caused by a significant tone of the posterior femoral muscles.
Cheek syndrome. When the doctor presses on the patient's cheeks, the sick child lifts his shoulders up, bending the elbow joints occurs.
Contraction of facial muscles in the process of tapping the zygomatic arch (Bekhterev's syndrome).
Lessage's symptom is inherent in infants up to a year. It lies in the fact that the baby involuntarily bends the legs when it is lifted up and held by the armpits.
Mondonesi syndrome - very strong pain that appears with slight pressure on the closed eyelids.
Brudzinski's symptom. Upper type - if a small patient lies on his back, his legs will involuntarily bend at the knees when the doctor makes an attempt to tilt his head to the sternum. The average symptom is that the lower limbs of the child bend when pressing on the pubic joint. When one leg bends at the knee joint and hip, and the second takes an identical position, this is the lower symptom of Brudzinsky.

For children under one year old

Standard general signs of meningitis in infants:

partial or complete refusal of food, liquid;
the appearance of rashes, yellowing of the skin;
severe vomiting (attacks will often recur);
hypoglycemia (low blood sugar levels) may begin;
neck muscle tension;
lethargy (hypotension), weakness;
temperature rise;
the baby is irritated, naughty;
swelling of the fontanel also refers to the signs of meningitis in children under one year old.

Rash with meningitis

Often, a child develops a rash with meningitis, which is caused by a microorganism such as meningococcus. When an infectious disease has a mild form, the rashes look like small dots of dark red color. As a rule, after a few days this symptom disappears. The severe course of the disease causes a rash in the form of large spots, bruises. The localization of this sign of meningitis is the arms, legs, torso. Eruptions are located asymmetrically.

Symptoms of meningitis

Doctors divide the symptoms of meningitis into three types: general infectious, meningeal, cerebral. These factors are discussed in more detail below. The first signs of meningitis in children of a general infectious nature:

severe pain in the head, muscles;
dyspnea;
elevated temperature;
cardiopalmus;
skin blanching;
pain in the abdomen;
loss of appetite;
symptoms of meningitis in children include a feeling of intense thirst;
blue nasolabial triangle.

Specific meningeal symptoms in children:

increasing headache;
moodiness, anxiety, crying caused by touching the baby (explained by muscle pain);
constant vomiting "fountain" (does not depend on the diet);
convulsions;
more symptoms of meningitis in children - photophobia, a negative reaction to loud sounds;
dark rash (hemorrhagic rash);
tension in the muscles of the neck;
meningeal signs in children - deterioration of vision and hearing;
hallucinations may occur;
frequent dizziness, fainting;
falling into a coma.

Common symptoms of meningitis in children include:

constant bouts of vomiting, after which there is no relief;
the appearance of a bright venous mesh on the eyelids, the head of the child;
disturbances in consciousness;
intense pain in the head;
dilation of blood vessels in the fundus;
convulsions: from twitching of individual muscles to severe seizures;
in infants with meningitis, there may be a divergence of the cranial sutures.

The first symptoms of meningitis

Neuroinfection often appears suddenly: the child feels well, and literally the next day the first symptoms of meningitis may appear. They are more pronounced initially in children of the older age group, and in babies of the first year of life, symptoms are not always immediately observed. The incubation period of inflammatory pathology of the brain is from two to ten days. After the “activation” of the infectious agents, the first general intoxication symptoms appear:

delusional state, clouding of consciousness;
nausea, severe vomiting;
sudden jump in temperature to high levels;
muscle pain;
unbearable headache, which is often accompanied by fainting;
increased tactile, visual and auditory sensitivity.

Teenagers

When the infection enters the lining of the brain, the first signs of meningitis appear in a teenager. The manifestations of the disease in children from ten years old are almost the same as those of an adult man or woman. The main symptoms of meningitis in adolescents are:

sudden increase in temperature (37-39 degrees);
rhinitis can also be a symptom of meningitis;
nausea, severe vomiting;
loss of appetite;
intense headaches;
rashes on the body;
muscle rigidity;
general malaise, drowsiness, weakness.

Serous meningitis

The rapid development of a lesion of the meninges, which is characterized by serous inflammation, is serous type meningitis. Often such a diagnosis is made for children from three to six years old. The disease can develop for several days or cause a rapid inflammatory process, which is subject to urgent treatment. Symptoms of serous meningitis in children include:

dizziness, loss of consciousness;
hallucinations caused by high temperature (more than 38 degrees);
convulsions;
tremor of the limbs;
paresis of the facial nerve, impaired motor coordination;
severe pain in the head, provoked by an increase in intracranial pressure.

Diagnostics

Before prescribing treatment, the specialist conducts diagnostic measures. The examination of the child is carried out using different methods. The main ways to diagnose meningitis:

First, the infectious disease doctor (or neuropathologist) conducts a conversation with the patient's parents. Finds out how long they have noticed the symptoms of the disease, how pronounced they are. This is followed by a thorough examination of the sick child to identify and confirm symptoms.
Puncture from the lower back (cerebrospinal fluid sampling). Lumbar puncture helps to check the exact diagnosis and determine the type of meningitis.
Cytological study of cerebrospinal fluid (fluid from the ventricles of the brain). Inflammation of the meninges is established if the cerebrospinal fluid flows out in jets during puncture or an increase in the level of lymphocytes is recorded in it.
X-ray and computed tomography of the skull are used to determine the causative agent of the infection and the nature of the inflammation.
Immunological analysis - detection of antibodies, viral antigens. There are two types of research: polymer chain reaction (PCR) and ELISA.
Analysis for the detection of diplococci and cocci in the body. For this, mucus is taken from the nasopharynx, skin scrapings and blood smears.

Video

Currently, less than 15-20% of newborns with sepsis develop meningitis. Mortality from meningitis, according to the literature, ranges from 20-25 to 33-48%.

There is no clear specificity of the microbiological picture; the flora transmitted to the newborn from the mother is characteristic.

Causes of meningitis in newborns

Ways of spread of infection:

most often hematogenous (as a result of bacteremia);
along the length - with infected defects of the soft tissues of the head;
along the perineural lymphatic pathways, often coming from the nasopharynx.

The inflammatory process in meningitis is most often localized in the soft and arachnoid membranes (leptomeningitis), less often in the dura mater (pachymeningitis). However, in newborns, all membranes of the brain are more affected. Through the perivascular spaces, the infection can spread to the substance of the brain, causing encephalitis, and to the ependyma of the ventricles (ventriculitis). Purulent meningitis is rare. The absence of an inflammatory response may be the result of a rapidly progressive infection, with an interval of only a few hours from the onset of clinical manifestations to death, or may reflect an inadequate response of the body to infection.

Consequences of meningitis in newborns

swelling of the brain;
the development of vasculitis leads to the prolongation of inflammation, the development of phlebitis, which may be accompanied by thrombosis and complete occlusion of blood vessels (often veins); occlusion of several veins can lead to the development of a heart attack;
hemorrhages in the parenchyma of the brain;
hydrocephalus as a result of closing the aqueduct or opening of the IV ventricle with purulent exudate or through inflammatory disorders of CSF resorption through the arachnoid;
subdural effusion, cortical atrophy, encephalomalacia, porencephaly, brain abscess, cysts.

Symptoms and signs of meningitis in newborns

early manifestations are nonspecific:
- deterioration in general well-being;
- fluctuations in body temperature;
- gray-pale skin;
- marbling of the skin;
- poor microcirculation;
physical inactivity, increased tactile sensitivity, hypotension;
unwillingness to drink, vomiting;
cyanosis, tachycardia, shortness of breath, episodes of apnea;
tachycardia, bradycardia;
late manifestations:
- piercing cry;
- tense fontanel;
- opisthotonus;
- convulsions.

Initial signs are common to all neonatal infections, they are non-specific and depend on birth weight and maturity. In most cases, signs are not characteristic of CNS disease (episodes of apnea, eating disorders, jaundice, pallor, shock, hypoglycemia, metabolic acidosis). Obvious signs of meningitis are observed only in 30% of cases. Neurological symptoms may include both lethargy and irritability, convulsions, and bulging of the large fontanel. Meningitis as a manifestation of RNS usually develops in the first 24-48 hours of life.

Diagnosis of meningitis in newborns

Lumbar puncture for CSF analysis. Complete blood count, CRV, blood glucose, electrolytes; coagulogram, blood culture.

Diagnosis is based on microbiological methods (isolation of a culture of microorganisms from CSF and blood cultures). CSF cultures are positive in 70-85% of patients who have not previously received antibiotic therapy.

Negative cultures may be obtained during antibiotic therapy, brain abscess, infection caused by M. hominis, U. urealyticum, Bacteroidesfragilis, enteroviruses, or herpes simplex virus. Infectious meningitis in newborns is characterized by an increase in the protein content in the CSF and a decrease in the concentration of glucose. The number of leukocytes in the CSF is usually increased due to neutrophils (more than 70-90%).

Despite the large variation in CSF cellular composition, the CSF leukocyte content of >21 cells per 1 mm3 for culture-proven meningitis is generally accepted (sensitivity - 79%, specificity - 81%). Cytological and biochemical methods (changes in the cellular and biochemical composition of CSF) are not always specific.

CSF glucose should be at least 55-105% of the blood glucose level in premature babies, and 44-128% in full-term babies. Protein concentration may be low (<0,3 г/л) или очень высокой (>10 g/l).

There is no unequivocal opinion on the need to study CSF in patients with RNS. The American Academy of Pediatrics recommends a spinal tap for newborns in the following situations:

positive blood culture;
clinical or laboratory evidence strongly suggests bacterial sepsis;
deterioration during antimicrobial treatment.

Lumbar puncture, if necessary, may be delayed until the condition stabilizes, although in this case there is a risk of delay in diagnosis and possibly inappropriate use of antibiotics. If a neonate with suspected sepsis or meningitis has abnormal CSF values, but blood and CSF cultures are negative, repeat lumbar puncture should be performed to rule out anaerobic, mycoplasmal, or fungal infections; it is also necessary to study the CSF for herpes, cytomegalovirus, toxoplasmosis. Late analysis (delay more than 2 hours) can significantly reduce the number of leukocytes and the concentration of glucose in the CSF. The optimal delivery time of the material to the laboratory should not exceed 30 minutes.

Meningitis with normal values. Up to 30% of newborns with GBS meningitis may have normal CSF values. In addition, even microbiologically confirmed meningitis does not always lead to changes in the cellular composition of the CSF. Sometimes, in addition to increased CSF pressure, another pathology in the CSF may not be detected, or the indicators may be "borderline". In doubtful cases, for example, with “borderline” CSF values (leukocytes> 20 per 1 mm3 or protein> 1.0 g / l), in the presence of clinical symptoms, it is necessary to examine newborns for the presence of specific infections (syphilis, rubella, cytomegalovirus, herpes, AIDS virus).

Microscopy with Gram stain. Organisms in Gram-stained CSF smears are found in 83% of neonates with GBS meningitis and in 78% of neonates with Gram-negative meningitis.

The probability of visualizing bacteria on a Gram stain correlates with the concentration of bacteria in the CSF. Isolation of CSF culture is critical to the diagnosis, regardless of other findings. A complete study of the CSF is all the more necessary, since the pathogen isolated from the blood will not always correspond to the CSF culture.

Ventricular puncture should be considered for meningitis that does not respond clinically or microbiologically to antibiotic therapy due to ventriculitis, especially if there is obstruction between the cerebral ventricles and between the ventricles and the spinal canal.

Treatment of meningitis in newborns

Antibiotics, anticonvulsants, possibly sedatives.

IVL at violations of regulation of breath. Patient monitoring. Careful control of the level of consciousness. Seizures? A bulging, tense fontanel?

For the treatment of meningitis, the same antibiotics are chosen that are used for the treatment of RNS, since these diseases are caused by similar pathogens. Empiric therapy for meningitis usually involves a combination of ampicillin (or amoxicillin) at antimeningitis doses and an aminoglycoside, or a third-generation cephalosporin or a fourth-generation cephalosporin in combination with an aminoglycoside; for infection caused by methicillin-resistant Staphylococcus aureus, vancomycin is used; for candidal meningitis, amphotericin B. If herpes is suspected, initial antibiotic therapy should be supplemented with acyclovir.

After isolation of the pathogen from the CSF and / or blood, antibiotic therapy is adjusted in accordance with the sensitivity of the microflora.

The concentration of aminoglycosides may not reach a sufficient level in the CSF to suppress the flora, so it seems understandable to suggest that some experts prefer third-generation cephalosporins. However, third-generation cephalosporins should not be used as monotherapy for the empiric treatment of meningitis due to resistance of L. monocytogenes and enterococci to all cephalosporins. Doses of antibacterial drugs must be selected, taking into account their permeability through the blood-brain barrier (you must read the instructions for the drug). Currently, most investigators do not recommend intrathecal or intraventricular antibiotics for neonatal meningitis.

48-72 hours after the start of antibiotic therapy, it is necessary to re-examine the CSF to monitor the effectiveness of treatment. IV antibiotic therapy should be continued after CSF sterilization for at least 2 weeks. with GBS or Listeria, or 3 weeks if the causative agent is gram-negative bacteria. Consider longer duration if focal neurologic signs persist for more than 2 weeks, if CSF sterilization takes more than 72 hours, or if obstructive ventriculitis, infarction, encephalomalacia, or abscess is present. In such circumstances, the duration of therapy can be determined using repeated lumbar punctures. With pathological indicators of CSF (glucose concentration<1,38 ммоль/л, содержание белка >3 g/l or the presence of polymorphonuclear cells >50%), with no other explanation for this, continued antimicrobial therapy is assumed to prevent relapse. After the end of the course of antibiotic therapy, a repeated examination of the brain by various methods of neuroimaging is indicated. Currently, MRI is the best method for assessing the state of the brain in a newborn.

Care

Carefully, regularly monitor vital signs.

The exact balance of the injected and excreted fluid is important, since there is a danger of cerebral edema.

Prognosis of meningitis in newborns

Among children with GBS meningitis, the mortality rate is about 25%. From 25 to 30% of surviving children have serious neurological complications, such as spastic quadriplegia, profound mental retardation, hemiparesis, deafness, blindness. From 15 to 20% - mild and moderate neurological complications. Newborns with meningitis caused by gram-negative bacteria die in 20-30% of cases, in survivors, neurological complications occur in 35-50% of cases. They include hydrocephalus (30%), epilepsy (30%), developmental delay (30%), cerebral palsy (25%) and hearing loss (15%).

Purulent meningitis in newborns - inflammation of the brain
membranes, a serious disease that occupies one of the first places among infectious
CNS diseases in young children. The incidence of purulent meningitis
is 1-5 per 10 thousand newborns.

It can result in death or disabling
complications (hydrocephalus, blindness, deafness, spastic paresis and paralysis,
epilepsy, delayed psychomotor development up to oligophrenia). Exodus
depends on timely intensive treatment. Etiology and pathogenesis.

According to the etiology, meningitis is divided into viral, bacterial and
fungal. The route of infection is hematogenous. Child infection
can occur in utero, including during childbirth or postnatally.
Sources of infection are the genitourinary tract of the mother, infection is also
can occur from a patient or from a carrier of pathogenic microflora. Development
meningitis is usually preceded by hematogenous spread of infection.
Microorganisms overcome the blood-brain barrier and enter the CNS.
Predisposing factors include maternal urinary tract infections,
chorioamnionitis, long anhydrous period (over 2 hours), intrauterine
infection, prematurity, intrauterine hypotrophy of the fetus and its
morphofunctional immaturity, fetal and newborn asphyxia, intracranial
birth trauma and related therapeutic measures, malformations
CNS and other situations where there is a decrease in immunological factors
protection. The penetration of a bacterial infection into the bloodstream of a child is facilitated by
inflammatory changes in the nasal and pharyngeal mucosa in acute respiratory
viral infection, which, according to our observations, often accompanies the onset
purulent meningitis.

The causative agents of meningitis are now often
Streptococcus agalactiae (group B beta-hemolytic streptococcus) and
Escherichia coli. Meningococcal etiology of purulent meningitis in newborns
is now rarely observed, which, apparently, is due to the passage
through the mother's placenta to the fetus immunoglobulin G containing antibodies to
meningococcus. Intrauterine meningitis usually presents clinically in
the first 48-72 hours after birth, postnatal meningitis appears later.
According to our data, such children were admitted to the clinic on the 20th-22nd day of life,
when there is a decrease in the content of immunoglobulin G obtained from the mother,
in the blood serum of the newborn. By this time, maternal immunoglobulin G
catabolized and its level in the blood decreases by 2 times.

Postnatal meningitis can also develop in departments
resuscitation and intensive care and in the departments of nursing premature babies.
Their main pathogens are Klebsiella spp., Staphylococcus aureus,
P.aeroginosae and fungi of the genus Candida. As our observations showed, in the anamnesis
mothers noted such risk factors as the threat of abortion,
infection of the urinary system, the presence of chronic foci of infection in pregnant women
(tonsillitis, sinusitis, adnexitis, vaginal thrush), as well as long-term
anhydrous interval in childbirth (from 7 to 28 hours).

Despite the diversity of causative agents of purulent meningitis in
newborns, morphological changes in the central nervous system are similar in them. They are localized in
mainly in soft and arachnoid shells. Exudate is removed by
phagocytosis by macrophages of fibrin and necrotic cells. For some it
undergoes organization, which is accompanied by the development of adhesions.
Violation of the patency of the cerebrospinal fluid can lead to the development of occlusive
hydrocephalus. Reparation can be delayed for 2-4 weeks or more.

Clinic and diagnostics

There are difficulties in diagnosing purulent meningitis both at home,
and when the child is admitted to the hospital, since clear clinical manifestations
develop later, and at first there are nonspecific symptoms similar to
many infectious and inflammatory diseases (pallor, marbling,
skin cyanosis, conjugative jaundice, hyperesthesia, vomiting). Some children
there is an increase in temperature to subfebrile figures. Symptoms of the disease
develop gradually. The child's condition is progressively deteriorating. Temperature
rises to 38.5-39оС. On examination, the skin is pale, sometimes with a grayish
shade, acrocyanosis, marbling are often noted, sometimes children have pronounced
conjugative jaundice. Respiratory system disorders -
decrease in respiratory rate, apnea attacks, and from the side of the cardiovascular
system is characterized by bradycardia. Patients also have hepato- and
splenomegaly.

In neurological status in some newborns
there are signs of CNS depression: lethargy, drowsiness, weakness, decreased
physiological reflexes, muscle hypotension. Others have symptoms
CNS excitation: restlessness, hyperesthesia, painful and
piercing scream, tremor of the chin and limbs, foot clonus. Violations with
cranial nerve sides may present as nystagmus, floating
movements of the eyeballs, strabismus, a symptom of the "setting sun". Some
children experience regurgitation and repeated vomiting, sluggish suckling, or refusal to breastfeed
and nipples. A sick child is not gaining weight well. At a later date
head tilting back, meningeal symptoms (tension
and bulging of the large fontanel, stiffness of the muscles of the back of the neck).
Characteristic posture of the child on its side with the head thrown back, legs bent and
pressed to the stomach. Meningeal symptoms typical of older children (Kernig,
Brudzinsky), are uncharacteristic for newborns. Sometimes there is a positive
Lessage's symptom: the child is lifted up, taking the armpits, and in this
while his legs are in a flexion position. Polymorphs may be seen
convulsions, paresis of cranial nerves, changes in muscle tone. The reason for the development
seizures are hypoxia, microcirculatory disorders, cerebral edema, and sometimes
hemorrhagic manifestations. In some cases there are
rapidly progressive increase in head circumference, divergence of cranial sutures after
account of intracranial hypertension.

Analysis of case histories of newborns with purulent meningitis,
were in our clinic, revealed that they all arrived at the age of 7 to
28 days of life (average age - 23 days). When referred to a hospital, only 2
purulent meningitis was suspected in children; in the rest, the guiding diagnosis was
ARVI, enterocolitis, conjugative jaundice, intrauterine infection, infection
urinary system, osteomyelitis. At admission, most newborns do not
there were clear and characteristic signs of meningitis. However, anamnestic
data and serious condition allowed us to consider that the disease began earlier,
which was confirmed by studies of the cerebrospinal fluid. Upon admission to
Most of the children had an increase in temperature up to 38-39.6°C. Expressed
catarrhal phenomena, as a rule, were not. Some children in clinical
there were manifestations of a local purulent infection (purulent conjunctivitis,
omphalitis, urinary tract infection).

In the blood test, most children showed inflammatory
changes in the form of an increase in the number of leukocytes (13-34.5x109 / l) with a significant
an increase in the number of stab neutrophils up to the appearance of young forms,
as well as an increase in ESR up to 50 mm / h.

Changes in urine tests (leukocyturia) were observed in three
children with a combination of purulent meningitis with pyelonephritis.

To confirm the diagnosis, a lumbar puncture should be
carry out at the slightest suspicion of meningitis, in the early stages, without waiting
development of his expanded clinic. In cases where, for whatever reason,
succeed in performing a lumbar puncture, one should be guided by the clinical
picture of the disease. Lumbar puncture for purulent meningitis in
in newborns, cerebrospinal fluid often leaks under pressure, is cloudy,
sometimes, with a large cytosis, yellow color, thick. Contraindication to
lumbar puncture is performed by shock and DIC.

In our observations, almost all admitted children
The diagnosis was made on the first day of hospital stay. Indication for
urgent lumbar puncture were the presence of febrile temperature
(above 38 ° C), symptoms of infectious toxicosis without a visible focus of bacterial
infections, less often - hyperesthesia. In the liquor there was an increase in the content
leukocytes with a predominance of the neutrophil link (more than 60%).

With purulent meningitis, the content of total protein in the cerebrospinal fluid
rises later than neutrophilic pleocytosis increases. Protein content
increases from the onset of the disease and may serve as an indicator of the duration
pathological process. In our studies, the protein concentration fluctuated
from 0.33 0/00 to 9 0/00. Increased protein content in the cerebrospinal fluid,
obtained at the first puncture, it was found in 10 patients that
indicated a certain duration of the disease. For purulent
meningitis is characterized by a low level of glucose in the cerebrospinal fluid.

In order to identify the pathogen and determine its
sensitivity to antibiotics microbiological examination is carried out
liquor. In our observations, clinical and laboratory data indicated
purulent nature of meningitis, while the sowing of cerebrospinal fluid and bacterioscopy of a smear in
In most cases, the pathogen was not identified. Two patients were found
group B beta-hemolytic streptococcus, one had a hemophilic
coli, and another has pneumococcus.

Serous inflammation is characteristic of viral meningitis
meninges with an increase in the content of lymphocytes in the cerebrospinal fluid. Serous
meningitis is characterized by a milder course.

Instrumental methods include ultrasonic
examination of the brain (neurosonography) and computed tomography,
which are carried out according to indications.

Neurosonography allows diagnosing ventriculitis,
expansion of the ventricular system, the development of a brain abscess, and to identify
severe concomitant intracranial hemorrhages, ischemic infarcts, malformations
development.

Computed tomography is indicated to rule out abscess
brain, subdural effusion, as well as to identify areas of thrombosis, infarcts
and hemorrhages in brain structures.

Complications

The most common early complications are edema and
swelling of the brain and convulsive syndrome.

Clinically, cerebral edema is manifested by increasing intracranial
hypertension. During this period, the posture of the newborn is characteristic with
head thrown back, monotonous, sometimes piercing,
scream, sometimes turning into a groan. Possible bulging of a large fontanel, its
pulsation, divergence of cranial sutures. Cerebral edema can be clinically manifested
dysfunction of the oculomotor, facial, trigeminal and sublingual
nerves. Coma is clinically manifested by depression of all types of cerebral
activity: adynamia, areflexia and diffuse muscular hypotension. Further
there is a disappearance of the reaction of the pupils to light, apnea attacks become more frequent,
bradycardia develops.

With purulent meningitis, convulsive syndrome often develops.
Initially, convulsions are clonic in nature, and as the edema progresses
brain are transformed into tonic.

A very dangerous complication of meningitis is
bacterial (septic) shock. Its development is associated with penetration into
bloodstream of a large number of bacterial endotoxins. Clinically
septic shock is manifested by sudden cyanosis of the extremities, catastrophic
decrease in blood pressure, tachycardia, shortness of breath, groaning weak cry,
loss of consciousness, often in combination with disseminated syndrome
intravascular coagulation. Among the newborns observed by us, two children
died. One girl was admitted on the 11th day of life and died in the first 6 hours
hospital stay from infectious-toxic shock, complicated
disseminated intravascular coagulation. Second girl aged
17 days died on the 2nd day after admission. She had intrauterine
generalized cytomegalovirus infection and purulent meningitis developed.
Severe consequences of purulent meningitis can be hydrocephalus, blindness,
deafness, spastic paresis and paralysis, oligophrenia, epilepsy.

Differential Diagnosis

Similar to purulent meningitis neurological symptoms
can be observed in the presence of intracranial hemorrhage in a newborn. At
such children also have motor restlessness, chin tremor and
limbs, nystagmus, strabismus, a symptom of the "setting sun". For exclusion
purulent meningitis requires a lumbar puncture. For
intraventricular hemorrhage is characterized by the presence in the cerebrospinal fluid of a large
the number of altered erythrocytes, as well as an increased concentration of total protein
in the cerebrospinal fluid from the first days of the disease due to the penetration of plasma proteins and
lysis of erythrocytes.

Often purulent meningitis occurs with vomiting, so it is necessary
conduct differential diagnosis with pyloric stenosis, in which
there is vomiting "fountain" without fever and inflammatory
changes in the blood test. Abdominal examination often shows a positive
hourglass symptom. The main methods for diagnosing pyloric stenosis are
esophagogastroduodenoscopy and ultrasound.

Symptoms of excitation of the central nervous system
(anxiety, tremor of the limbs and chin, hyperesthesia), similar to purulent
meningitis, can be observed with influenza and SARS. In this case, there is
meningism is a condition characterized by the presence of clinical and cerebral
symptoms without inflammatory changes in the cerebrospinal fluid. Meningism is not caused
inflammation of the meninges, and their toxic irritation and increased
intracranial pressure. On lumbar puncture, the fluid is clear and
colorless, flows out under high pressure, often in a jet, but the content
cells, protein, and glucose are normal. Meningismus usually presents with acute
period of illness and often precedes inflammation of the meninges, which
can develop within a few hours after its detection. If a
meningeal symptoms with influenza and SARS do not disappear, or, moreover, increase,
repeated diagnostic spinal punctures are necessary.

Suppurative meningitis may occur in a child with sepsis, which
significantly aggravates the clinical picture of the disease.

Treatment

Newborns with purulent meningitis need a comprehensive
treatment, including antibiotic, infusion therapy, substitution
intravenous immunoglobulin therapy. If necessary
hormonal, anticonvulsant, dehydration therapy is carried out. So
children need the most gentle mode. In the acute period they are not recommended.
breastfeed. They receive expressed breast milk or, in the absence of
his mother, formula from a bottle. When the sucking reflex is suppressed
feeding the child through a tube is applied.

Etiotropic antibiotic therapy is the main
method of treatment of newborns with purulent meningitis. It is carried out taking into account
isolated from the cerebrospinal fluid of the pathogen and its sensitivity to
antibiotics. If the pathogen was not found, the effectiveness of the antibacterial
therapy is assessed by clinical data and the results of a repeated study
liquor no later than 48-72 hours from the start of treatment. If during this time not
there is a clear clinical and laboratory improvement, a change is made
antibacterial treatment. In neonates with purulent meningitis, antibiotics
must be administered intravenously three or four times at the maximum allowable doses
through a subclavian catheter.

Use antibiotics that penetrate through
blood-brain barrier and have a wide spectrum of antimicrobial activity.
A combined course of antibiotic therapy usually includes
third generation cephalosporins (ceftazidime, ceftriaxone) and aminoglycoside
(amikacin, netilmicin, gentamicin). To all children treated by us
antibiotic therapy was prescribed immediately upon admission to the hospital and
included a cephalosporin. After receiving the result of the lumbar puncture in the scheme
combined antibiotic therapy, a second antibiotic was added
aminoglycoside series. If a second course of antibiotics is needed when not
it was possible to achieve an improvement in the patient's condition and normalization of indicators
cytosis in the CSF, the children received a second course of antibiotic therapy
meropenem, vancomycin.

The question of hormonal therapy was decided
individually, taking into account the severity of the condition. With severe purulent meningitis
hormone therapy in the acute period of the disease led to an earlier
the disappearance of fever and intoxication, the improvement of the condition of the newborn.

For the treatment of hypertension-hydrocephalic syndrome
dehydration was carried out using furosemide. Subsequently, after
elimination of symptoms of infectious toxicosis, in the presence of intracranial
hypertension was prescribed acetazolamide according to the scheme.

As our observations have shown, a good effect is obtained by including in
a treatment regimen to increase the body's defenses of immunoglobulin for
intravenous administration, which is especially effective in the early stages of the disease.
Immediately after the diagnosis was established, all patients were started on intravenous
administration of immunoglobulin. It was administered 2 to 5 times with obligatory laboratory
control (determination of immunoglobulins G, M and A) before and after administration. More
frequent administration was required by children who had a slow positive dynamics
clinical and laboratory symptoms.

Viferon in suppositories containing recombinant human
leukocyte interferon alfa-2b, connected later, after improvement
clinical and laboratory indicators. It was administered at a dose of 150,000 IU 2 times a day,
the duration of the course was 10 days.

Simultaneously with the start of antibiotic therapy in children,
started intensive infusion therapy through the subclavian catheter, including
transfusion of solutions of glucose, rheopolyglucin, vitamins (C, B6,
cocarboxylase), furosemide, antihistamines for the purpose of detoxification,
improvement of microcirculation, correction of metabolic disorders.

Diazepam was used to relieve convulsive syndrome. FROM
phenobarbital was prescribed for maintenance anticonvulsant therapy.
They also used drugs that improve cerebral circulation (Vinpocetine,
cinnarizine, pentoxifylline).

The average stay of patients in the clinic was 26 days (from 14
up to 48 days).

Forecast and long-term consequences

Purulent meningitis in newborns is a serious disease,
mortality from which remains high.

As our studies have shown, complex intensive
therapy of purulent meningitis in newborns, started at an early stage
diseases, gives good results. Supervision for 1-3 years for children,
who had purulent meningitis in the neonatal period, showed that the majority
of which, with early detection of the disease and adequate therapy, psychomotor
development is age appropriate. However, two children developed progressive
hydrocephalus, four had violations of muscle tone and
subcompensated hypertensive-hydrocephalic syndrome.

Purulent meningitis in newborns is an inflammation of the meninges, a serious disease that occupies one of the first places among infectious diseases of the central nervous system in young children. The incidence of purulent meningitis is 1-5 per 10 thousand newborns.

It can end in death or disabling complications (hydrocephalus, blindness, deafness, spastic paresis and paralysis, epilepsy, psychomotor retardation up to oligophrenia). The outcome depends on timely intensive treatment started. Etiology and pathogenesis.

According to the etiology, meningitis is divided into viral, bacterial and fungal. The route of infection is hematogenous. Infection of a child can occur in utero, including during childbirth or postnatally. Sources of infection are the urogenital tract of the mother, infection can also occur from a patient or from a carrier of pathogenic microflora. The development of meningitis is usually preceded by hematogenous spread of infection. Microorganisms overcome the blood-brain barrier and enter the CNS. Predisposing factors are maternal urinary tract infections, chorioamnionitis, prolonged anhydrous period (over 2 hours), intrauterine infection, prematurity, intrauterine fetal hypotrophy and its morphofunctional immaturity, asphyxia of the fetus and newborn, intracranial birth trauma and related therapeutic measures, malformations of the central nervous system and other situations where there is a decrease in immunological protective factors. The penetration of a bacterial infection into the child's bloodstream is facilitated by inflammatory changes in the nasal and pharyngeal mucosa during acute respiratory viral infection, which, according to our observations, often accompanies the onset of purulent meningitis.

Streptococcus agalactiae (group B beta-hemolytic streptococcus) and Escherichia coli are now common causative agents of meningitis. Meningococcal etiology of purulent meningitis in newborns is now rare, which, apparently, is due to the passage of immunoglobulin G containing antibodies to meningococcus through the placenta of the mother to the fetus. Intrauterine meningitis, as a rule, clinically manifests itself in the first 48-72 hours after birth, postnatal meningitis appears later. According to our data, such children were admitted to the clinic on the 20th-22nd day of life, when there was a decrease in the content of immunoglobulin G obtained from the mother in the blood serum of the newborn. By this time, maternal immunoglobulin G is catabolized and its blood level decreases by 2 times.

Postnatal meningitis can also develop in intensive care units and intensive care units and in nursing units for premature babies. Their main pathogens are Klebsiella spp., Staphylococcus aureus, P.aeroginosa and fungi of the genus Candida. As our observations showed, in the anamnesis of mothers there were such risk factors as the threat of abortion, infection of the urinary system, the presence of chronic foci of infection in pregnant women (tonsillitis, sinusitis, adnexitis, vaginal thrush), as well as a long anhydrous interval in childbirth (from 7 to 28 hours).

Despite the variety of causative agents of purulent meningitis in newborns, the morphological changes in the central nervous system are similar in them. They are localized mainly in the soft and arachnoid membranes. Removal of exudate occurs by phagocytosis by macrophages of fibrin and necrotic cells. In some, it undergoes organization, which is accompanied by the development of an adhesive process. Violation of the patency of the cerebrospinal fluid can lead to the development of occlusive hydrocephalus. Reparation can be delayed for 2-4 weeks or more.

Clinic and diagnostics

There are difficulties in diagnosing purulent meningitis both at home and when a child is admitted to a hospital, since clear clinical manifestations develop later, and at first there are nonspecific symptoms similar to many infectious and inflammatory diseases (pallor, marbling, cyanosis of the skin, conjugative jaundice, hyperesthesia , vomit). Some children have an increase in temperature to subfebrile numbers. Symptoms of the disease develop gradually. The child's condition is progressively deteriorating. The temperature rises to 38.5-39oC. On examination, the skin is pale, sometimes with a grayish tint, acrocyanosis, marbling are often noted, sometimes conjugative jaundice is expressed in children. There are violations of the respiratory system - a decrease in the frequency of breathing, apnea attacks, and bradycardia is characteristic of the cardiovascular system. Patients also have hepato- and splenomegaly.

In the neurological status, some newborns show signs of CNS depression: lethargy, drowsiness, weakness, decreased physiological reflexes, and muscle hypotension. Others have symptoms of CNS excitation: restlessness, hyperesthesia, painful and piercing scream, tremor of the chin and limbs, foot clonuses. Cranial nerve disorders may present with nystagmus, eyeball floaters, strabismus, and the "setting sun" sign. Some children experience regurgitation and repeated vomiting, sluggish sucking, or refusal of the breast and nipples. A sick child is not gaining weight well. In later periods, head tilting back, meningeal symptoms (tension and bulging of the large fontanel, stiffness of the muscles of the back of the neck) appear. Characteristic posture of the child on the side with the head thrown back, legs bent and pressed to the stomach. Meningeal symptoms typical of older children (Kernig, Brudzinsky) are uncharacteristic for newborns. Sometimes a positive symptom of Lessage is noted: the child is lifted up, taking the armpits, and at this time his legs are in a flexion position. Polymorphic convulsions, paresis of cranial nerves, changes in muscle tone can be observed. The cause of the development of seizures are hypoxia, microcirculatory disorders, cerebral edema, and sometimes hemorrhagic manifestations. In some cases, there is a rapidly progressive increase in head circumference, divergence of cranial sutures due to intracranial hypertension.

Analysis of the case histories of newborns with purulent meningitis who were in our clinic revealed that all of them were admitted at the age of 7 to 28 days of life (mean age - 23 days). When sent to the hospital, only 2 children were suspected of purulent meningitis, the rest of the referral diagnosis was acute respiratory viral infections, enterocolitis, conjugative jaundice, intrauterine infection, infection of the urinary system, osteomyelitis. At admission, the majority of newborns did not show clear and characteristic signs of meningitis. However, the anamnestic data and serious condition suggested that the disease began earlier, which was confirmed by studies of the cerebrospinal fluid. At admission, most of the children had an increase in temperature up to 38-39.6°C. As a rule, there were no pronounced catarrhal phenomena. Some children in the clinical picture had manifestations of a local purulent infection (purulent conjunctivitis, omphalitis, infection of the urinary system).

In the blood test, most children showed inflammatory changes in the form of an increase in the number of leukocytes (13-34.5x109/l) with a significant increase in the number of stab neutrophils up to the appearance of young forms, as well as an increase in ESR up to 50 mm/hour.

Changes in urine tests (leukocyturia) were observed in three children with a combination of purulent meningitis with pyelonephritis.

To confirm the diagnosis, lumbar puncture should be performed at the slightest suspicion of meningitis, in the early stages, without waiting for the development of its detailed clinic. In cases where for some reason it is not possible to perform a lumbar puncture, one should focus on the clinical picture of the disease. During lumbar puncture with purulent meningitis in newborns, the cerebrospinal fluid often flows out under pressure, cloudy, sometimes, with large cytosis, yellow, thick. Shock and DIC are contraindications for lumbar puncture.

In our observations, almost all admitted children were diagnosed on the first day of their stay in the hospital. The indications for urgent lumbar puncture were the presence of febrile temperature (above 38°C), symptoms of infectious toxicosis without a visible focus of bacterial infection, less often hyperesthesia. In the cerebrospinal fluid, there was an increase in the content of leukocytes with a predominance of the neutrophil link (more than 60%).

With purulent meningitis, the content of total protein in the cerebrospinal fluid increases later than neutrophilic pleocytosis increases. The protein content increases from the onset of the disease and can serve as an indicator of the duration of the pathological process. In our studies, the protein concentration ranged from 0.33 0/00 to 9 0/00. An increased protein content in the cerebrospinal fluid obtained during the first puncture was found in 10 patients, which indicated a certain duration of the disease. Purulent meningitis is characterized by a low level of glucose in the cerebrospinal fluid.

In order to identify the pathogen and determine its sensitivity to antibiotics, a microbiological study of the cerebrospinal fluid is carried out. In our observations, clinical and laboratory data indicated the purulent nature of meningitis, while CSF culture and smear bacterioscopy in most cases did not reveal the pathogen. Group B beta-hemolytic streptococcus was detected in two patients, Haemophilus influenzae was sown in one patient, and pneumococcus was inoculated in another.

Viral meningitis is characterized by serous inflammation of the meninges with an increase in the content of lymphocytes in the cerebrospinal fluid. Serous meningitis is characterized by a milder course.

Instrumental methods include ultrasound examination of the brain (neurosonography) and computed tomography, which are performed according to indications.

Neurosonography allows diagnosing ventriculitis, expansion of the ventricular system, the development of a brain abscess, as well as identifying severe concomitant intracranial hemorrhages, ischemic infarcts, and malformations.

Computed tomography is indicated to rule out a brain abscess, subdural effusion, and to identify areas of thrombosis, infarcts, and hemorrhages in brain structures.

Complications

The most common early complications are cerebral edema and swelling and seizures.

Clinically, cerebral edema is manifested by increasing intracranial hypertension. During this period, the posture of a newborn with its head thrown back is characteristic, a monotonous, sometimes piercing, cry, sometimes turning into a groan, is noted. Bulging of a large fontanel, its pulsation, divergence of cranial sutures are possible. Cerebral edema can be clinically manifested by impaired function of the oculomotor, facial, trigeminal, and hypoglossal nerves. Coma is clinically manifested by inhibition of all types of cerebral activity: adynamia, areflexia and diffuse muscular hypotension. Further, the disappearance of the reaction of pupils to light is noted, apnea attacks become more frequent, and bradycardia develops.

With purulent meningitis, convulsive syndrome often develops. Initially, convulsions are clonic in nature, and as cerebral edema progresses, they transform into tonic ones.

A very dangerous complication of meningitis is bacterial (septic) shock. Its development is associated with the penetration of a large number of bacterial endotoxins into the bloodstream. Clinically, septic shock is manifested by sudden cyanosis of the extremities, a catastrophic decrease in blood pressure, tachycardia, shortness of breath, groaning weak cry, loss of consciousness, often in combination with disseminated intravascular coagulation. Among the newborns we observed, two children died. One girl was admitted on the 11th day of life and died in the first 6 hours of hospitalization from infectious-toxic shock complicated by disseminated intravascular coagulation. The second girl, aged 17 days, died on the 2nd day after admission. She had intrauterine generalized cytomegalovirus infection and developed purulent meningitis. Severe consequences of purulent meningitis can be hydrocephalus, blindness, deafness, spastic paresis and paralysis, mental retardation, epilepsy.

Differential Diagnosis

Neurological symptoms similar to purulent meningitis can be observed if a newborn has intracranial hemorrhage. These children also have motor restlessness, tremor of the chin and limbs, nystagmus, strabismus, a symptom of the "setting sun". To exclude purulent meningitis, a spinal puncture is necessary. Intraventricular hemorrhage is characterized by the presence in the cerebrospinal fluid of a large number of altered erythrocytes, as well as an increased concentration of total protein in the cerebrospinal fluid from the first days of the disease due to the penetration of plasma proteins and lysis of erythrocytes.

Often, purulent meningitis occurs with vomiting, so it is necessary to carry out a differential diagnosis with pyloric stenosis, in which vomiting is observed with a "fountain" without fever and inflammatory changes in the blood test. Often, when examining the abdomen, a positive hourglass symptom is noted. The main methods for diagnosing pyloric stenosis are esophagogastroduodenoscopy and ultrasound.

Symptoms of excitation of the central nervous system (anxiety, tremor of the limbs and chin, hyperesthesia), similar to purulent meningitis, can occur with influenza and SARS. In this case, meningism occurs - a condition characterized by the presence of clinical and cerebral symptoms without inflammatory changes in the cerebrospinal fluid. Meningism is not caused by inflammation of the meninges, but by their toxic irritation and increased intracranial pressure. During lumbar puncture, the fluid is clear and colorless, flows out under high pressure, often in a jet, but the content of cells, protein, and glucose is normal. Meningismus usually manifests itself in the acute period of the disease and often precedes inflammation of the meninges, which can develop within a few hours after its detection. If meningeal symptoms with influenza and SARS do not disappear, or, moreover, increase, repeated diagnostic spinal punctures are necessary.

Purulent meningitis can occur in a child with sepsis, which significantly aggravates the clinical picture of the disease.

Treatment

Newborns with purulent meningitis need complex treatment, including antibacterial, infusion therapy, substitution therapy with immunoglobulins for intravenous administration. If necessary, hormonal, anticonvulsant, dehydration therapy is carried out. Such children require the most sparing treatment. In the acute period, they are not recommended to breastfeed. They receive expressed breast milk or, if the mother does not have it, formula from a bottle. When the sucking reflex is suppressed, the child is fed through a tube.

Etiotropic antibiotic therapy is the main treatment for newborns with purulent meningitis. It is carried out taking into account the pathogen isolated from the cerebrospinal fluid and its sensitivity to antibiotics. If the pathogen was not found, the effectiveness of antibiotic therapy is assessed according to clinical data and the results of a repeated examination of the cerebrospinal fluid no later than 48-72 hours from the start of treatment. If during this time there is no obvious clinical and laboratory improvement, the antibiotic treatment is changed. In newborns with purulent meningitis, antibiotics should be administered intravenously three or four times at the maximum allowable doses through a subclavian catheter.

Use antibiotics that penetrate the blood-brain barrier and have a wide spectrum of antimicrobial activity. A combined course of antibiotic therapy usually includes third-generation cephalosporins (ceftazidime, ceftriaxone) and an aminoglycoside (amikacin, netilmicin, gentamicin). All children treated by us were prescribed antibiotic therapy immediately upon admission to the hospital and included cephalosporin. After receiving the result of lumbar puncture, a second antibiotic of the aminoglycoside series was added to the combination antibiotic therapy regimen. If a second course of antibiotics was needed, when it was not possible to improve the patient's condition and normalize the cytosis parameters in the cerebrospinal fluid, the children received a second course of antibiotic therapy with meropenem and vancomycin.

The issue of hormone therapy was decided individually, taking into account the severity of the condition. In severe cases of purulent meningitis, hormonal therapy in the acute period of the disease led to an earlier disappearance of fever and intoxication, and an improvement in the condition of the newborn.

For the treatment of hypertension-hydrocephalic syndrome, dehydration was performed using furosemide. Subsequently, after the elimination of the symptoms of infectious toxicosis, in the presence of intracranial hypertension, acetazolamide was prescribed according to the scheme.

As our observations have shown, a good effect is the inclusion of immunoglobulin for intravenous administration in the treatment regimen in order to increase the body's defenses, which is especially effective in the early stages of the disease. Immediately after the diagnosis was established, all patients began intravenous administration of immunoglobulin. It was administered 2 to 5 times with obligatory laboratory control (determination of immunoglobulins G, M and A) before and after administration. More frequent administration was required by children who had a slow positive dynamics of clinical and laboratory symptoms.

Viferon in suppositories containing recombinant human leukocyte interferon alfa-2b was connected later, after improvement of clinical and laboratory parameters. It was administered at a dose of 150,000 IU 2 times a day, the duration of the course was 10 days.

Simultaneously with the start of antibiotic therapy in children, intensive infusion therapy was started through a subclavian catheter, which included the transfusion of glucose solutions, rheopolyglucin, vitamins (C, B6, cocarboxylase), furosemide, antihistamines to detoxify, improve microcirculation, and correct metabolic disorders.

Diazepam was used to relieve convulsive syndrome. Phenobarbital was prescribed for maintenance anticonvulsant therapy. Means that improve cerebral circulation (vinpocetine, cinnarizine, pentoxifylline) were also used.

The average stay of patients in the clinic was 26 days (from 14 to 48 days).

Forecast and long-term consequences

Purulent meningitis in newborns is a serious disease, the lethality of which remains high.

As our studies have shown, complex intensive therapy of purulent meningitis in newborns, started at the earliest stage of the disease, gives good results. Observation for 1-3 years of children who had purulent meningitis in the neonatal period showed that in most of them, with early detection of the disease and adequate therapy, psychomotor development corresponds to age. However, two children developed progressive hydrocephalus, four had impaired muscle tone and subcompensated hypertensive-hydrocephalic syndrome.

Children who have had purulent meningitis in the neonatal period should be observed by a pediatrician and a neurologist.

Oleg BOTVINEV, Head of the Department of Pediatrics, FPPO MMA named after. I.M. Sechenov.

Irina RAZUMOVSKAYA, Associate Professor.

Vera DORONINA, postgraduate student.

Alla SHALNEVA, head of the neonatal department, Children's Clinical Hospital No. G.N. Speransky of Moscow.