Abstract: Objective　To investigate the clinical features and risk factors of white matter damage (WMD) in neonatal purulent meningitis. Methods　A total of 170 cased of full-term neonates with purulent meningitis hospitalized in the NICU between January 2008 to January 2018 were retrospectively enrolled in the study. Clinical data were retrospectively analyzed by univariate and logistic multivariate regression analysis. Results　Of the 170 full-term neonates enrolled, 32 cases were combined with WMD (case group), and the remaining 138 cases were concurrent with no WMD (control group). There were 17 cases of WMD had a confirmed bacterial etiology, and the most common of which are Group B beta-hemolytic streptococcus (GBS) (n=6) and Escherichia coli (n=4). There was no significant difference between Gram positive cocci and Gram negative bacilli in concurrent WMD (P < 0.05). There were significant differences between GBS and Burkholderia cepacia in concurrent WMD (P < 0.05). A total of 8 cases (25%) had EEG abnormalities in neonates with WMD, and 16 cases (50%) had hearing impairment. The incidence of EEG abnormalities and hearing impairment increased significantly (P<0.01). The univariate analysis showed the factors related with WMD were as follows: convulsion, altered level of consciousness, bulging fontanel, CRP＞100 mg/L, Cerebrospinal fluid composition change (CSF-WBC＞ 500×106/L、CSF-LDH＞300 U/L、CSF-Pro＞2.0 g/L，CSF-Glu＜1.1 mmol/L) and positive bacterial culture (all P<0.05). According to the logistic multivariate regression analysis, convulsion (OR=5.284), CSF-WBC (OR=4.218) ), CSF-LDH (OR=3.634), positive bacterial culture (OR=3.123) were high risk factors for WMD in neonatal purulent meningitis. ROC curve analysis showed that CSF-WBC, CSF-LDH were effective predictors for WMD, with the area under ROC curve were 0.707, 0.672, respectively. Conclusion　Neonatal purulent meningitis complicated with severe manifestations, and prematurity and abnormal laboratory indicators were high risk factors for WMD, which should be highly vigilant in clinical practice, and active treatment should be given.

Key words: 　purulent meningitis;　white matter damage; neonate