Meningite bacteriana neonatal: estudo prospectivo da evolução a longo prazo de 55 crianças

Abstract

RESUMO -Foram estudadas prospectivamente 55 crianças que apresentaram meningite bacteriana no período neonatal, com o objetivo da analisar a frequência e o tipo de sequelas neurológicas. Todas as crianças nasceram a termo, sendo 38 do sexo masculino e 17 do feminino; a idade de início da doença variou de 3 a 28 dias. Os principais agentes etiológicos foram as enterobactérias. O tempo médio de seguimento foi 5 anos. A frequência de sequelas neurológicas foi 67,3%, representadas principalmente pelo atraso do desenvolvimento neuropsicomotor (58,2%), hidrocefalia (45,5%) e convulsões (34,5%). As alterações motoras graves ocorreram em 23,6% dos pacientes (tetraplegia, diplegia, hemiparesia e ataxia). As convulsões na fase aguda da doença e a cultura positiva do líquido cefalorraqueano estiveram associadas significativamente com a presença de sequelas. Na avaliação do desempenho escolar, realizada em 25 crianças, observaram-se dificuldades na aprendizagem em 48% dos casos, associadas significativamente à deficiência mental.PALAVRAS-CHAVE: recém-nascido, meningite, seguimento.Vários estudos têm mostrado que a meningite bacteriana neonatal representa causa importante de morbimortalidade infantil, apesar dos avanços nas áreas da terapêutica antimicrobiana e cuidados Neonatal bacterial meningitis: prospective study of the long term outcome of 55 childrenABSTRACT -Fifty-five infants who presented bacterial neonatal meningitis were prospectively studied to analyze the frequency and the type of sequelae. All the infants were full term newborns.There were 38 boys and 17 girls; the age of disease onset varied from 3 to 28 days. The causative organism was represented mainly by enterobacteriae. The median time of follow-up was 5 years. The frequency of neurologic sequelae was 63.7%, represented mainly by neuropsychomotor development delay (58.2%), hydrocephaly (45.5%) and convulsions (34.5%). Severe motor abnormalities ocurred in 23.6% of children (quadriplegia, diplegia, hemiparesia and ataxia). Convulsions in the acute phase of the disease and the positive cerebrospinal fluid culture were highly associated to sequelae. The school performance, obtained in 25 children, showed presence of disabilities in 48% of cases, which were significantly associated to mental retardation.

Clinical outcome of neonatal bacterial meningitis according to birth weight

“…Despite the decrease in mortality rate compared to prior studies conducted at the same Service, which showed mortality rates of 29% 10 and 26% 12 , the complications affected 50% of the patients in both groups. Others authors have emphasized the high morbidity of neonatal bacterial meningitis [11][12][13] , regardless of the decrease in the mortality.…”

“…The association between positive CSF culture and the presence of complications or death has been reported by other authors 9,12 . It is likely that the presence of bacteria or their products in the CSF is related to the maintenance of the infl ammatory cascade and central nervous system injury.…”

“…Others authors have emphasized the high morbidity of neonatal bacterial meningitis [11][12][13] , regardless of the decrease in the mortality. A surveillance study carried out in 2000 and 2001 revealed a mortality rate of 12.4% for meningitis due to B Streptococcus infection in England and Ireland and of 8% in the USA 13 .…”

“…Treatment of meningitis in the neonatal period is longer than therapy provided to all the other age groups because of the high severity of the disease in the newborn and the elevated risk of recurrence, which might affect 7 to 21% of the cases, even after a full treatment course 15,16 . The authors recommend that the antibiotic therapy is maintained for at least 14 to 21 days after CSF culture becomes negative 12,16 . Additionally, we recommend the systematic CSF analysis before treatment withdrawal.…”

Fatores de risco para meningite bacteriana no recém-nascido

“…Este comportamento pode ser atribuído, em parte, ao grande número de recém-nascidos pré-termo acometidos, ao tempo transcorrido entre o início da doença e a introdução do tratamento, ao tipo de bactéria, à sensibilidade do microorganismo aos antimicrobianos e à capacidade do antibiótico atingir o sítio de infecção [4][5][6] . A mortalidade nos diferentes centros de tratamento varia de 17% a 29%, com taxa de seqüelas de 15% a 68% dos sobreviventes 3,[7][8][9][10] . Entre os fatores que influenciam o prognóstico da doença estão a prematuridade, o peso de nascimento, o tipo de bactéria, a sensibilidade do germe ao antimicrobiano, a duração do tratamento e a presença de complicações.…”