Meningitis neonatal. Estudio epidemiológico del Grupo de Hospitales Castrillo

S1 guidelines "lumbar puncture and cerebrospinal fluid analysis" (abridged and translated version)

Introduction

Cerebrospinal fluid (CSF) analysis is important for detecting inflammation of the nervous system and the meninges, bleeding in the area of the subarachnoid space that may not be visualized by imaging, and the spread of malignant diseases to the CSF space. In the diagnosis and differential diagnosis of neurodegenerative diseases, the importance of CSF analysis is increasing. Measuring the opening pressure of CSF in idiopathic intracranial hypertension and at spinal tap in normal pressure hydrocephalus constitute diagnostic examination procedures with therapeutic benefits.Recommendations (most important 3-5 recommendations on a glimpse): The indications and contraindications must be checked before lumbar puncture (LP) is performed, and sampling CSF requires the consent of the patient.Puncture with an atraumatic needle is associated with a lower incidence of postpuncture discomfort. The frequency of postpuncture syndrome correlates inversely with age and body mass index, and it is more common in women and patients with a history of headache. The sharp needle is preferably used in older or obese patients, also in punctures expected to be difficult.In order to avoid repeating LP, a sufficient quantity of CSF (at least 10 ml) should be collected. The CSF sample and the serum sample taken at the same time should be sent to a specialized laboratory immediately so that the emergency and basic CSF analysis program can be carried out within 2 h.The indication for LP in anticoagulant therapy should always be decided on an individual basis. The risk of interrupting anticoagulant therapy must be weighed against the increased bleeding risk of LP with anticoagulant therapy.As a quality assurance measure in CSF analysis, it is recommended that all cytological, clinical-chemical, and microbiological findings are combined in an integrated summary report and evaluated by an expert in CSF analysis.

Conclusions

In view of the importance and developments in CSF analysis, the S1 guideline "Lumbar puncture and cerebrospinal fluid analysis" was recently prepared by the German Society for CSF analysis and clinical neurochemistry (DGLN) and published in German in accordance with the guidelines of the AWMF (https://www.awmf.org). /uploads/tx_szleitlinien/030-141l_S1_Lumbalpunktion_und_Liquordiagnostik_2019-08.pdf). The present article is an abridged translation of the above cited guideline. The guideline has been jointly edited by the DGLN and DGN.

Meningite neofatal: aspectos associados

INTRODUÇÃO: O objetivo deste estudo foi identificar e analisar fatores relacionados à meningite neonatal. MÉTODO: Em estudo de caso-controle, foram examinados neonatos com meningite no período de agosto/2002 a dezembro/2003 na Unidade de Tratamento Intensivo Neonatal (UTIN) e alocados recém-nascidos hígidos como grupo controle (GC). Foram relatados dados referentes à gestação, ao parto e ao neonato. Os resultados foram considerados significativos quando p (alfa)< 0,05. RESULTADOS: Foram examinados 42 neonatos com meningite e 42 controles. A média numérica de consultas durante o pré-natal foi menor no grupo meningite (GM). As intercorrências mais comuns detectadas nas gestações, em ambos os grupos, foram o uso de substâncias de abuso, infecções, pré-eclâmpsia, diabetes melitus gestacional e infecções do trato urinário. O sofrimento fetal e a utilização de cuidados respiratórios foram associados à meningite. O GM apresentou médias menores de peso e de índice de APGAR em relação ao GC. A prevalência de prematuridade e de neonatos pequenos para a idade gestacional foi significativamente maior no GM. O exame neurológico foi alterado em apenas 35,7% dos casos de meningite. CONCLUSÃO: Em nosso meio, a associação de fatores de risco relacionados à gestação, ao parto e próprios do neonato com o desfecho de meningite neonatal não diferiu da literatura.

Trends in the epidemiology of neonatal sepsis of vertical transmission in the era of group B streptococcal prevention

AIM

To assess trends in the epidemiology of culture-proven and clinical neonatal sepsis of vertical transmission in the era of intrapartum antibiotic prophylaxis.

METHODS

Since 1995, the neonatal services of 28 acute-care teaching hospitals in Spain ("Grupo de Hospitales Castrillo") have been involved in the prospective surveillance of neonatal infection of vertical transmission. We here report the comparison of the incidence for the periods 1996-1997 and 2000-2001, and look separately at two groups of hospitals according to the time at which the official hospital policy to provide intrapartum antibiotic prophylaxis for group B Streptococcus (GBS) prevention was adopted. In 16 hospitals the policy was adopted in 1999 and in 10 before 1998 (nine hospitals in 1996, one in 1997).

RESULTS

The incidence of proven sepsis decreased significantly by 22% and 54% in the hospitals that started prophylaxis in 1999 and before 1998, respectively. The incidence of GBS sepsis also declined significantly by 36.4% and 65.4% in both groups of hospitals, respectively. Significant variations in the incidence of clinical vertical sepsis as well as in the incidence of sepsis caused by Haemophilus influenzae and Klebsiella were not found. Sepsis caused by Escherichia coli increased in the hospitals with prophylaxis from 1999 and decreased in those that began prophylaxis before 1998, in which the mortality rate of proven and clinical sepsis also decreased significantly by 58.6%.

CONCLUSIONS

There was a substantial decline in the incidence of proven vertical sepsis, with a significant reduction of GBS sepsis, although decreases were more marked when antibiotic prophylaxis was started before 1998. In this group of hospitals, there was also a decrease in the mortality rate. Fluctuations in the incidence of E. coli infection suggest the need for continuing epidemiological surveillance.