Clinical outcome and prognosis of neonatal bacterial meningitis

Objectives: To study the epidemiological, clinical, and bacteriological aspects as well as the outcome of neonatal bacterial meningitis and analyze the factors of poor prognosis of this condition. Patients and methods: We report a retrospective analysis of 44cases of neonatal bacterial meningitis hospitalized in the pediatric unit of Tahar Sfar Hospital in Mahdia, Tunisia, between January 1996and December 2010. Inclusion criteria were infants less than 29days of age who were hospitalized for bacterial meningitis diagnosed on either the presence of bacteria in cerebrospinal fluid or with more than 50cells/mm3, predominance of neutrophils, and the protein level greater than 1.2g/l.Clinical data were obtained through the analysis of patient files. Statistical analysis was based on the Chi2test, and P-values less than 0.05were considered statistically significant. Results: The incidence of neonatal bacterial meningitis was 0.49per 1000live births. The patients were premature in 20.4% and low birth weight in 13.6% of cases. The clinical presentation was not specific for most cases. The main signs at admission were hyperthermia (43.2%), refusal to nurse (20.4%), seizures (18.2%), and respiratory distress (13.6%). The cerebrospinal fluid culture was positive in 36.4% of cases. The group B streptococcus was the most frequently isolated (62.5%) followed by Escherichia coli (12.5%). The association of cefotaxime-ampicillin-gentamicin was used as the first treatment in all cases. Ofloxacin was associated with initial antibiotic therapy during the first 5days in 20.4% of cases. The mortality rate was 15.9% and the rate of neurological sequelae in survivors was 21.6%. Prematurity, low birth weight, shock, respiratory distress, and pleocytosis of less than 500cells/mm3were the main factors of a poor prognosis. The addition of ofloxacin to the initial antibiotic therapy was associated with a decreased rate of neurological sequelae in survivors (11% vs. 25%, P=0.042). Conclusion: This study emphasizes the severity of neonatal bacterial meningitis with high rates of mortality and neurological sequelae, especially in premature and low birth weight infants. An early diagnosis and effective antibiotic therapy is needed to improve the prognosis. © 2013 Elsevier Masson SAS.