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

Krebs, Vera Lúcia Jornada; Diniz, Edna Maria de Albuquerque; Vaz, Flávio Adolfo Costa; Dias, Maria Joaquina Marques; Takiguti, Clóvis; Ramos, José Lauro Araújo

doi:10.1590/S0004-282X1996000100013

Resumos

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.

recém-nascido; meningite; seguimento

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.

meningitis; newborn; follow-up

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

Neonatal bacterial meningitis: prospective study of the long term outcome of 55 children

Vera Lúcia Jornada Krebs^I; Edna Maria de Albuquerque Diniz^II; Flávio Adolfo Costa Vaz^III; Maria Joaquina Marques Dias^IV; Clóvis Takiguti^V; José Lauro Araújo Ramos^VI

^IDoutora em Pediatria (USP), Médica-Assistente da Unidade de Cuidados Intensivos para Recém-nascidos Externos (UCIRNE) de ICr do HC/FMUSP

^IIProfessora Livre-Docente em Pediatria Neonatal (USP), responsável pela UCIRNE do ICr do HC/FMUSP

^IIIProfessor-Associado do Departamento de Pediatria da FMUSP, Diretor do Serviço de Pediatria Neonatal do HC/FMUSP

^IVDoutora em Neurologia (USP), Chefe da Unidade de Neuropediatria do ICr HC/FMUSP

^VProfessor-Associado do Departamento de Medicina Preventiva da FMUSP

^VIProfessor Titular do Departamento de Pediatria da FMUSP

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.

ABSTRACT

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.

Key words:meningitis, newborn, follow-up.

Texto completo disponível apenas em PDF.

Full text available only in PDF format.

Aceite: 10-outubro-1995

Instituto da Criança (ICr) do Hospital das Clínicas (HC) da Faculdade de Medicina (FM) da Universidade de São Paulo (USP)

Dra. Vera Lúcia Jornada Krebs - Instituto da Criança HC/FMUSP - Av. Dr. Enéas de Carvalho Aguiar 647 -05403-000 São Paulo SP Brasil. FAX 011 853 2602.

1. Alon U, Naveh Y, Gardos N, Friedman A. Neurological sequelae of septic meningits: a follow-up study of 65 children. Isr J Med Sci 1979; 15:512-517.
2. Aujard Y, Crépy A, Bingen E. Les méningites bactériennes du nouveau-né. Jornées Nationales de Néonatologie 1992; 21:341-353.
3. Bennet R, Bergdahl S, Eriksson M, Zetterström R. The outcome of neonatal septicemia during fifteen years. Acta Paediatr Scand 1989; 78:40-43.
4. Berman PH, Banker BQ. Neonatal meningitis: a clinical an pathological study of 29 cases. Pediatrics 1966; 38: 6-24.
5. Cervantes-Pardo A, Tauler Girona MC, Lopez-Soler C, Puche Mira A, Casas Fernandez C, Rodriguez Costa T. Meningitis neonatal: estúdio de 28 casos y revision de sus secuelas a los cinco anos. An Esp Pediatr 1988; 28:503-507.
6. Chin KC, Fitzhardinge PM. Sequelae of early-onset group B hemolytic streptococcal neonatal meningitis. J Pediatr 1985; 106:819-822.
7. Dodge FR, Davis H, Feign R, Holmes S, Kaplan SL, Jubelirer DP, Stechenberg BW, Hirsh SK. Prospective evaluation of hearing impairment as a sequela of acute bacterial meningitis. N Engl J Med 1984; 311: 769-874.
8. Franco SM, Cornelius VE, Andrews BF. Long-term outcome of neonatal meningitis. Am J Dis Child, 1992; 146:567-571.
9. Gonsu-Fotsin J, Kago I, Dzogang MT, Kanga HG, Camara M. Cerebral complications of purulent meningitis in children assessed by transfontanellar ultrasonography in Yaound (Cameroon). Ann Radiol 1990; 33:195-199.
10. Keane WM, Potsic WP, Roew LD, Konkle DF. Meningitis and hearing lost in children. Arch Otolaryngol 1979; 105:39-44.
11. Klein JO, Marcy SM. Bacterial sepsis and meningitis. In: Remington JS, Klein, JO, (eds.). Infectious diseases of the fetus and newborn infant. Ed. 3 Philadelphia: Saunders, 1990; 601-656.
12. Lebel MH, Freij BJ, Syrogiannopoulos GA, Chrane DF, Hoyt MJ, Stewart SM, Kennard BD, Olsen KD, McCracken GH Jr. Dexamethasone therapy for bacterial meningitis: results of two double-blind, placebo-controlled trials. N Engl J Med 1988; 319:964-971.
13. Lewis BR, Gupta JM. Present prognosis in neonatal meningitis. Med J Aust, 1977; 1:695-697.
14. McCracken GH Jr. The rate of bacteriologic response to antimicrobial therapy in neonatal meningitis. Am J Dis Child, 1972; 123: 547-553.
15. McCracken GH Jr, Mustafa MM, Ramilo O, Olsen KD, Risser RC. Cerebrospinal fluid interleukin 1-beta and tumor necrosis factor concentrations and outcome from neonatal Gram-negative enteric bacillary meningitis. Pediatr Infect Dis J 1989; 8:155-159.
16. McCraken GH Jr, Sarff LD. Endotoxin in cerebrospinal fluid: detection in neonates with bacterial meningitis. JAMA, 1976; 235:617-620.
17. McCracken GH Jr, Sarff LD, Glode MP, Mize SG, Schiffer MS, Robbins JB, Gotschlich EC, Orskov I, Orskov F. Relation between Escherichia coli K1 capsular polysaccharide antigen and clinical outcome in neonatal meningitis. Lancet 1974; 2:246-250.
18. Moodley M, Bullock MR. Severe neurological sequelae of childhood bacterial meningitis. S Afr Med J 1985; 68:566-571
19. Mustafa MM, Lebel MH, Ramilo O, Olsen KD, Reisch JS, Beutler B, McCracken GH Jr. Correlation of interleukin-1 -beta and cachectin concentrations in cerebrospinal fluid and outcome from bacterial meningitis. J Pediatr 1989; 115:208-213.
20. Pomeroy SL, Holmes SJ, Dodge PR, Feigin RD. Seizures and other neurologic sequelae of bacterial meningitis in children. N Engl J Med 1990; 323:1651-1657.
21. Rinaldi G, Magaldi R, Marciello G. La meningite del neonato: aspetti clinici e di laboratório di 16 casi. Minerva Pediatr 1982; 34:897-904.
22. Rusconi F, Parizzi F, Garlaschi L, Assael BM, Sironi M, Chezzi P, Mantovani A. Interleukin 6 activity in infants and children with bacterial meningitis. Pediatr Infect Dis J, 1991; 10:117-121.
23. Sáez-Lorens X, Ramilo O, Mustafa MM, Mertsola J, McCracken GH Jr. Molecular pathophysiology of bacterial meningitis: current concepts and therapeutic implications. J Pediatr 1990; 116:671-684.
24. Sáchez-Saucedo LU, Gonzalez-Yunez RA, Avila-Figueroa C, Santos JI. Meningitis neonatal: observaciones sobre etiologia, mortalidad y secuelas. Bol Med Hosp Infant Mex 1990; 47: 772-776.
25. Unhanand M, Mustafa MM, McCracken GH Jr, Nelson JD. Gram-negative enteric bacillary meningitis: a twenty-one-year experience. J Pediatr 1993; 122:15-21.
26. Volpe JJ. Neurology of the newborn. Ed 2. Philadelphia: Saunders, 1987; p. 129-157 (Neonatal seizures).
27. Wardle S, Carty H CT. Scanning in meningitis. Eur J Radiol, 1991; 12:113-119.
28. Wechsler D. Wechsler preschool and primary scale of intelligence. San Antonio: Harcourt Brace Jovanovich, 1989.
²⁹
World Health Organization. International classification of impairments, disabilities and handicaps. Geneva: WHO, 1980.
30. Zahi M, Daoud AS, Al Saleh Q, Abd Al Rassol MM. Bacterial meningitis in the newborn: a Kuwaiti experience. J Trop Pediatr 1990; 36:63-65.

Datas de Publicação

Publicação nesta coleção
07 Dez 2010
Data do Fascículo
Mar 1996

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 1. Alon U, Naveh Y, Gardos N, Friedman A. Neurological sequelae of septic meningits: a follow-up study of 65 children. Isr J Med Sci 1979; 15:512-517.

[2] 2. Aujard Y, Crépy A, Bingen E. Les méningites bactériennes du nouveau-né. Jornées Nationales de Néonatologie 1992; 21:341-353.

[3] 3. Bennet R, Bergdahl S, Eriksson M, Zetterström R. The outcome of neonatal septicemia during fifteen years. Acta Paediatr Scand 1989; 78:40-43.

[4] 4. Berman PH, Banker BQ. Neonatal meningitis: a clinical an pathological study of 29 cases. Pediatrics 1966; 38: 6-24.

[5] 5. Cervantes-Pardo A, Tauler Girona MC, Lopez-Soler C, Puche Mira A, Casas Fernandez C, Rodriguez Costa T. Meningitis neonatal: estúdio de 28 casos y revision de sus secuelas a los cinco anos. An Esp Pediatr 1988; 28:503-507.

[6] 6. Chin KC, Fitzhardinge PM. Sequelae of early-onset group B hemolytic streptococcal neonatal meningitis. J Pediatr 1985; 106:819-822.

[7] 7. Dodge FR, Davis H, Feign R, Holmes S, Kaplan SL, Jubelirer DP, Stechenberg BW, Hirsh SK. Prospective evaluation of hearing impairment as a sequela of acute bacterial meningitis. N Engl J Med 1984; 311: 769-874.

[8] 8. Franco SM, Cornelius VE, Andrews BF. Long-term outcome of neonatal meningitis. Am J Dis Child, 1992; 146:567-571.

[9] 9. Gonsu-Fotsin J, Kago I, Dzogang MT, Kanga HG, Camara M. Cerebral complications of purulent meningitis in children assessed by transfontanellar ultrasonography in Yaound (Cameroon). Ann Radiol 1990; 33:195-199.

[10] 10. Keane WM, Potsic WP, Roew LD, Konkle DF. Meningitis and hearing lost in children. Arch Otolaryngol 1979; 105:39-44.

[11] 11. Klein JO, Marcy SM. Bacterial sepsis and meningitis. In: Remington JS, Klein, JO, (eds.). Infectious diseases of the fetus and newborn infant. Ed. 3 Philadelphia: Saunders, 1990; 601-656.

[12] 12. Lebel MH, Freij BJ, Syrogiannopoulos GA, Chrane DF, Hoyt MJ, Stewart SM, Kennard BD, Olsen KD, McCracken GH Jr. Dexamethasone therapy for bacterial meningitis: results of two double-blind, placebo-controlled trials. N Engl J Med 1988; 319:964-971.

[13] 13. Lewis BR, Gupta JM. Present prognosis in neonatal meningitis. Med J Aust, 1977; 1:695-697.

[14] 14. McCracken GH Jr. The rate of bacteriologic response to antimicrobial therapy in neonatal meningitis. Am J Dis Child, 1972; 123: 547-553.

[15] 15. McCracken GH Jr, Mustafa MM, Ramilo O, Olsen KD, Risser RC. Cerebrospinal fluid interleukin 1-beta and tumor necrosis factor concentrations and outcome from neonatal Gram-negative enteric bacillary meningitis. Pediatr Infect Dis J 1989; 8:155-159.

[16] 16. McCraken GH Jr, Sarff LD. Endotoxin in cerebrospinal fluid: detection in neonates with bacterial meningitis. JAMA, 1976; 235:617-620.

[17] 17. McCracken GH Jr, Sarff LD, Glode MP, Mize SG, Schiffer MS, Robbins JB, Gotschlich EC, Orskov I, Orskov F. Relation between Escherichia coli K1 capsular polysaccharide antigen and clinical outcome in neonatal meningitis. Lancet 1974; 2:246-250.

[18] 18. Moodley M, Bullock MR. Severe neurological sequelae of childhood bacterial meningitis. S Afr Med J 1985; 68:566-571

[19] 19. Mustafa MM, Lebel MH, Ramilo O, Olsen KD, Reisch JS, Beutler B, McCracken GH Jr. Correlation of interleukin-1 -beta and cachectin concentrations in cerebrospinal fluid and outcome from bacterial meningitis. J Pediatr 1989; 115:208-213.

[20] 20. Pomeroy SL, Holmes SJ, Dodge PR, Feigin RD. Seizures and other neurologic sequelae of bacterial meningitis in children. N Engl J Med 1990; 323:1651-1657.

[21] 21. Rinaldi G, Magaldi R, Marciello G. La meningite del neonato: aspetti clinici e di laboratório di 16 casi. Minerva Pediatr 1982; 34:897-904.

[22] 22. Rusconi F, Parizzi F, Garlaschi L, Assael BM, Sironi M, Chezzi P, Mantovani A. Interleukin 6 activity in infants and children with bacterial meningitis. Pediatr Infect Dis J, 1991; 10:117-121.

[23] 23. Sáez-Lorens X, Ramilo O, Mustafa MM, Mertsola J, McCracken GH Jr. Molecular pathophysiology of bacterial meningitis: current concepts and therapeutic implications. J Pediatr 1990; 116:671-684.

[24] 24. Sáchez-Saucedo LU, Gonzalez-Yunez RA, Avila-Figueroa C, Santos JI. Meningitis neonatal: observaciones sobre etiologia, mortalidad y secuelas. Bol Med Hosp Infant Mex 1990; 47: 772-776.

[25] 25. Unhanand M, Mustafa MM, McCracken GH Jr, Nelson JD. Gram-negative enteric bacillary meningitis: a twenty-one-year experience. J Pediatr 1993; 122:15-21.

[26] 26. Volpe JJ. Neurology of the newborn. Ed 2. Philadelphia: Saunders, 1987; p. 129-157 (Neonatal seizures).

[27] 27. Wardle S, Carty H CT. Scanning in meningitis. Eur J Radiol, 1991; 12:113-119.

[28] 28. Wechsler D. Wechsler preschool and primary scale of intelligence. San Antonio: Harcourt Brace Jovanovich, 1989.

[29] ²⁹
World Health Organization. International classification of impairments, disabilities and handicaps. Geneva: WHO, 1980.

[30] 30. Zahi M, Daoud AS, Al Saleh Q, Abd Al Rassol MM. Bacterial meningitis in the newborn: a Kuwaiti experience. J Trop Pediatr 1990; 36:63-65.