Clinical Characteristics and Predictors of Adverse Outcomes at Discharge in Neonates with Bacterial Meningitis at a Tertiary Hospital in Suzhou, China

Background: Neonatal bacterial meningitis is a severe infectious disease with a high rate of death and neurological complications. Early clinical signs and outcomes are different between preterm and full-term neonates, and little is known about their combined predictors. Therefore, this study aimed to explore the clinical characteristics and predictors of in-hospital outcomes in neonates with bacterial meningitis. Methods: : We retrospectively analyzed hospitalized neonates with bacterial meningitis in the Department of Neonatology, Children’s Hospital of Soochow University from January 1,2013 to March 31, 2018. The clinical manifestations, laboratory data, treatment measures, neuroimaging and outcomes at discharge were recorded. Predictors of adverse outcomes were identified by using univariate analyses. Results: : There were 145 neonates diagnosed with bacterial meningitis enrolling in this study, with 39 preterm and 106 full-term neonates. The incidence rate of neonatal bacterial meningitis was 0.56%. There were 28 neonates with birth weight < 2,500 g (19.31%), and 33 neonates presented with an onset of less than 7 days (22.76%). The predominant pathogens were Escherichia coli and Group B Streptococcus (accounting for 42.00% and 32.00%, respectively). The median peak fever during the acute illness in full-term neonates was higher than that in preterm neonates (p<0.05). The median platelet counts in peripheral blood and white blood cells in cerebrospinal fluid in full-term neonates were higher than those in preterm neonates (p<0.05). The positive rate of blood cultures in preterm neonates was higher than that in full-term neonates (71.79% vs. 49.06%, p=0.02). The incidence rates of adverse outcomes at discharge were 10/39 (25.64%) and 23/106 (21.69%) in preterm and full-term neonates, respectively. Preterm neonates with bacterial meningitis who had reduced glucose levels in cerebrospinal fluid were more likely to have adverse outcomes at discharge, while full-term neonates who had a bulging anterior fontanel, seizure/convulsions and reduced glucose levels in cerebrospinal fluid were more likely to have worse outcomes. Conclusions: : The incidence rate of hospitalized neonates associated with bacterial meningitis remains high. Escherichia coli and Group B Streptococcus were the predominant pathogens in neonatal bacterial meningitis in our region. The risk factor for an adverse outcome at discharge in preterm neonates with bacterial meningitis was a lower cerebrospinal fluid glucose concentration, meanwhile, the risk factors in full-term neonates were a bulging anterior fontanel, seizure/convulsions, and a lower cerebrospinal fluid glucose concentration.