目的：探讨无乳链球菌（GBS）败血症合并脑膜炎新生儿的临床表现、治疗及预后情况。方法回顾性分析2012年1月至2015年5月收治的12例无乳链球菌脑膜炎新生儿的临床资料。结果12例患儿中，男女各6例，均为足月儿，早发型4例、晚发型8例，顺产7例、剖宫产5例，母亲均无明显感染病史，亦未行常规GBS筛查。新生儿血降钙素原均升高。头颅磁共振（MRI）可见脑膜强化，5例硬膜下积液，3例脑实质受累。1例单用青霉素，1例应用美罗培南之后降阶梯单用青霉素效果良好，大部分患儿需联合用药。随访20~29个月，1例语言发育落后，2例运动发育落后，其余9例发育正常。结论新生儿无乳链球菌败血症合并脑膜炎病情危重，需及时应用敏感抗生素，必要时联合用药。建议完善产前筛查。%Objective To investigate the clinical manifestations, treatment and prognosis of sepsis caused by Streptococcus agalactiae combined with purulent meningitis in neonates. Methods Clinical data of 12 neonates with purulent meningitis caused by Streptococcus agalactiae were analyzed retrospectively from January 2012 to May 2015. Results In 12 full term neonates (6 males and 6 females) , there were 4 early onset cases and 8 late onset cases;7 cases of vaginal delivery and 5 cases of cesarean section. All of the mothers had no history of infections, and also no routine screening for group B streptococcus. The serum levels of procalcitonin were elevated in all neonates. Brain magnetic resonance imaging results indicated abnormal meningeal enhancement, subdural effusion in 5 cases and brain parenchyma involvement in 3 cases. One case was treated with penicillin only. One case was treated with meropenem ifrst and then penicillin only with good efifcacy. Most of the neonates need drug combination therapy. During 20 ~ 29 months of following-up, one case had language development delays, 2 cases had motor retardation, and the other 9 cases had a normal development. Conclusions The neonates with sepsis caused by Streptococcus agalactiae combined with purulent meningitis are critically ill. It is imperative to apply sensitive antibiotics in time or drug combination therapy when necessary. It is proposed to improve the prenatal screening.
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