Clinical Features, Outcomes, Predictive Factors and Prognosis of Hydrocephalus in Neonatal Bacterial Meningitis: A Prospective Case-Control Study

Clinical Features, Outcomes, Predictive Factors and Prognosis of Hydrocephalus in Neonatal Bacterial Meningitis: A Prospective Case-Control Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article Clinical Features, Outcomes, Predictive Factors and Prognosis of Hydrocephalus in Neonatal Bacterial Meningitis: A Prospective Case-Control Study Jizhi xu, Ju LI, Guohui Lu, Meiling Huang, juncao Chen, Weiming Yuan This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7841321/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 01 May, 2026 Read the published version in Scientific Reports → Version 1 posted 10 You are reading this latest preprint version Abstract Hydrocephalus is one of the most common complications of bacterial meningitis (BM). A retrospective case-control study were conducted to evaluate the etiologies, predictive factors and adverse outcomes of hydrocephalus in BM. A total of 227 neonates who met the inclusion criteria were enrolled in the study cohort, of which 73 neonates with hydrocephalus. Escherichia coli and Group B streptococcus were the most common causative pathogens causing hydrocephalus. The factors that were significantly associated with hydrocephalus in multivariate analysis were: encephalopyosis, second CSF glucose 4 g/L, C-reactive protein (CRP) > 100 mg/L, third CSF WBC > 100×10^6/L, convulsion at onset, and initial CSF WBC > 5000×10^6/L. The receiver operating characteristic results also showed CSF WBC, CSF glucose, and protein level on the second LP also had predictive value for hydrocephalus. Neonates with hydrocephalus in BM had significantly higher ratio of secondary epilepsy, hearing impairment, encephalomalacia, and death in the two year of life (all P < 0.05). Together these data demonstrated that a severe clinical manifestation and significant CSF parameters at admission are the most important predictors of hydrocephalus in neonatal BM. Hydrocephalus in BM was significantly associated with mortality and poor outcome. Health sciences/Diseases Health sciences/Medical research Biological sciences/Microbiology Health sciences/Neurology Biological sciences/Neuroscience Bacterial meningitise Hydrocephalus Cerebrospinal fluid Predictive factors Prognosis Introduction Of all age categories, infants have the highest prevalence of bacterial meningitis (BM), which significantly increases infant mortality and morbidity globally 1 – 3 . According to population-based studies, up to 24% of patients who survive bacterial meningitis experience neurological sequelae 4 , 5 .These neurologic complications include hydrocephalus, subdural effusions or empyemas, sensorineural hearing loss, seizures, motor disorders, mental retardation, and behavioral problems 6 . The most common complication of BM is hydrocephalus, some studies demonstrated that the prevalence of hydrocephalus in BM (HBM) ranged from 9.36% to 34% 7–9 . A few studies have discussed the clinical characteristics of HBM in childhood 10 – 12 . However, information about clinical characteristics and prognostic variables for neonates with hydrocephalus in BM is lacking 13 , 14 . Moreover, in most of these studies, many children still die or suffer significant neurological sequelae because there is presently no effective medication treatment. Therefore, finding clinical features, and risk factors for this encephalopathy represents an important and urgent need. In this study, we reported on: (1) the clinical features of hydrocephalus and other neurologic complications that occured after BM; (2) the causative pathogens, the process of cerebrospinal fluid (CSF) parameters, and risk factors for HBM; and (3) the long-term outcomes of HBM. Methods Study Design Infants admitted to hospitals between September 2018 and March 2024 were included in this prospective case-control research. The study protocols were approved by the research ethical committee of hospitals. All families gave consent to the participate. Study Sample The neonates were categorized into two groups: the BM group, and neonates with HBM (HBM group). All infants underwent routine lumbar puncture (LP), complete regular follow-up for a minimum of 6 months and a maximum of 2 years. All patients underwent head magnetic resonance imaging (MRI) examination. The neonatal BM was diagnosed if met any criterion of the following: (I) positive CSF culture; or (II) CSF pleocytosis (white blood cells [WBC] ≥ 20/mm 3 ) with a predominance of polymorphonucleocytes (>50%), CSF glucose < 2.2 mmol/L or CSF glucose 40% lower than normal blood glucose level, and CSF protein is greater than 1.5g/L. For infants with traumatic lumbar punctures (ie, CSF RBC count 10 000 cells per mm 3 ), we used an red blood cells (RBC)/WBC correction factor of 1000:1 to determine the corrected CSF WBC count. Hydrocephalus could be diagnosed according to any of the following criteria: third ventricular diameter > 6 mm; fourth ventricular diameter > 12 mm; maximum frontal horn diameter > 45 mm; Evan index (maximum frontal horn diameter divided by maximum cranial diameter in that plane) > 0.3. The following were the criteria for exclusion: 1) the onset age of a full-term infant was greater than 28 days, and the corrected gestational age of a preterm infant was more than 44 weeks; 2) genetic syndromes, or chromosomal abnormalities; 3)previous nerve system procedures (e.g., myelomeningocele closure, ventriculoperitonieal shunts); 4) cerebral hemorrhages; 5) infection of the central nervous system that is not caused by bacteria. Data Collection For each included neonate, we abstracted historical, physical examination, and laboratory data, including results of the initial CSF profile for diagnostic purposes in patients with suspected BM (ie, WBC count, and protein and glucose levels), and CSF bacterial cultures; we also included the CSF profile of repeat LP that had been done 5–7 and 15-20 days after the initial lumbar puncture. We defined an adverse outcome as any of the following occurring a minimum of 6 months and a maximum of 2 years: death; neurologic sequelae (defined as hearing loss, seizures, or any abnormal cranial imaging). Epilepsy was characterized by an enduring predisposition for epileptic seizures, diagnosed by electroencephalography (EEG). Hearing impairment was measured by automated auditory brainstem response (AABR) and otoacoustic emission (OAE) tests which were the best methods of hearing assessment among diagnostic methods because of their specificity and sensitivity. A supervisor and a trained clerk entered the data. The co-author double-checked the data for mistakes and inconsistencies. Statistical Analysis Statistical analysis was performed using SPSS Statistics version 26.0 (SPSS Inc., Chicago, Illinois, USA). Means (standard deviations [SD]) or median (range) was used to describe continuous variables; t- tests, or mann-whitney μ test were used to analyze the differences in continuous variables. A two-sided chi-squared or Fisher's exact test was used for categorical variables presented as numbers and percentages. To identify risk factors for hydrocephalus in BM, univariate and multivariate regression analyses were used. A receiver operating characteristic (ROC) curve was used to determine the best cut-off value for diagnosis. Statistical significance was set at P <0.05. Results Baseline characteristics Relevant characteristics of infants with HBM were presented in Table 1. Over the 6 years, a total of 227 neonates who met the inclusion criteria were enrolled in the study cohort, of which 73 neonates with hydrocephalus. There was no significant difference between patients with and without hydrocephalus in sex, the type of delivery, birth weight, and days of onset. The clinical manifestations of HBM often lack specificity, and fever (n=65) was the most common symptom. MRI was completed in all cases. Of the 73 neonates with HBM, 25 cases (34.2%, 25/73) had 2 or more abnormalities complications, including subdural effusion (21, 28.8%), encephalopyosis (15, 20.5%) and ependymitis (19, 26.0%). Table 2 summarized the pathogens of BM with and without hydrocephalus. T he positive rate of CSF culture in patients with hydrocephalus was higher than that of neonates without hydrocephalus (63/73, 86.3%). In this study, the most common pathogens in patients with HBM were Escherichia coli (23/63, 36.5%), Group B streptococcus (19/63, 30.2%), and S treptococcus pneumoniae (6/63, 9.5%). Characteristics of CSF Table 3 compared CSF parameters between neonates with or without hydrocephalus. At the first CSF examination after the onset of meningitis, the CSF of hydrocephalus group had the higher WBC counts (median, 2451×10^6/L; range, 82-38426×10^6/L) and protein levels (mean, 4.37g/L; standard deviations (SD), 4.48 g/L), while had considerably lower level of glucose (mean, 0.89 mmol/L; SD, 1.08 mmol/L ), when compared to that in BM groups (all P < 0.05). Of these 227 cases, 217 neonates underwent repeat LP within the first 5-7 days. CSF WBC counts (median,736.5 ×10^6/L; range, 12-68637 ×10^6/L) and protein levels (mean, 4.14g/L; SD, 2.89g/L) were significantly higher in patients with hydrocephalus; in addition, the glucose (mean,1.17mmol/l; SD, 1.13mmol/l ) and CSF chloride levels (mean,117.86mmol/l; SD, 7.22mmol/l ) were lower in hydrocephalus group. 216 neonates underwent repeat LP at two weeks after the onset of meningitis. The CSF WBC of 72 patients without hydrocephalus had returned to normal during this period, but the CSF WBC of the hydrocephalus group was still significantly increased. Significant differences were found in CSF WBC counts, protein, glucose and chloride levels between two groups (all P < 0.05). Predictors of hydrocephalus Based on the results from Tables 4; on univariate analysis, risk factors associated with hydrocephalus were encephalopyosis ( P 4g/L ( P <0.001)，second CSF glucose <1.1 mmol/L ( P 4g/L ( P 500×10^6/L ( P 4g/L ( P <0.001), initial CSF glucose <1.1 mmol/L ( P 100mg/L ( P 5000×10^6/L ( P <0.001), positive bacterial culture( P= 0.002), and convulsion at onset( P= 0.003). Next, multivariate logistic regression was used to analyze the clinical parameters identified as significant in predicting hydrocephalus from the univariate analysis. The following parameters were identified as independent predictive factors for hydrocephalus in neonatal BM: encephalopyosis ( P <0.001, OR (95% confidence Interval [CI]) 48.47 [4.51-520.46]), second CSF glucose <1.1 mmol/L ( P 4g/L ( P= 0.001, OR (95% CI) 12.34[2.72-56.05]), CRP >100mg/L ( P= 0.008, OR (95% CI) 3.72[1.41-9.78]), third CSF WBC >100×10^6/L ( P= 0.016, OR (95% CI)3.33[1.25-8.86]), convulsion at onset( P= 0.03, OR (95% CI) 3.47[1.13-10.66]), and i nitial CSF WBC >5000×10^6/L ( P= 0.028, OR (95% CI) 3.34 [1.14-9.80]). These findings suggested that the CSF results of repeat LP within the first 5-7 days was very important, and could be identified as predictive factors for hydrocephalus in neonatal BM. Next, a ROC curve was used to evaluate the predictive value of second CSF characteristic for hydrocephalus; results were shown in Table 5. CSF WBC on the second LP yielded an area under the curve (AUC) of 0.820 (95% CI, 0.761−0.879; P < 0.001) for predicting sequelae at discharge from hospital, with a cut-off value of 204.5 × 10^6 /L, providing a sensitivity of 82.4% and specificity of 69.1%. In addition, second CSF glucose (the area under the ROC curve = 0.753; 95% confidence interval: 0.673-0.833) and protein level ( the area under the ROC curve = 0.818; 95% confidence interval: 0.758-0.879) also had predictive value for hydrocephalus. Follow up Follow-up of the subjects comprised a minimum of 6 months and a maximum of 2 years, and the outcomes of the infants were summarized in Table 6. Although the majority of neonates with hydrocephalus were given undergone surgical treatment; the rate of secondary epilepsy (37% vs. 3.9%), hearing impairment (53.4% vs. 15.6%), encephalomalacia (39.7% vs. 4.5%), and death (8.2% vs. 0.6%) in the hydrocephalus group were significantly higher than that in the BM group(all P < 0.001). DISCUSSION We conducted a case-control study to explore the clinical features of HBM in neonates. The main results of our study suggested the following:1) fever was the most common symptom in patients; Escherichia coli and Group B streptococcus were the most common causative pathogens causing hydrocephalus; 2) the CSF results of repeat LP within the first 5–7 days was very important, could be identified as predictive factors for HBM. 3) patients with hydrocephalus were more vulnerable to adverse outcomes. The utility of CSF parameters in diagnosing BM in infants is well-recognized, and endorsed by clinicians as the primary diagnostic approach 15 , 16 . Classically, BM is characterized by elevated CSF protein, WBCs, and decreased CSF glucose. Growing evidence suggests that intraventricular hemorrhage (IVH), and resultant post-hemorrhagic hydrocephalus (PHH) presented host-immune responses, then altered the CSF profile; the altered characteristics of CSF in IVH and PHH similar to those in BM 17 . When CSF culture is negative, BM and PHH are easily confused. So some neonates with IVH or PHH were misdignosed as BM or hydrocephalus in BM in earlier studies 13 , 18 . Therefore, we excluded neonates with concomitant IVH in our study. Despite some clinical factors demonstrating an association with hydrocephalus in adults and children, the risk factors contributing to hydrocephalus in neonatal meningitis have scantly been evaluated. The previous study showed that female sex was a predictor for hydrocephalus 19 ; other studies show that there was no correlation between the development of hydrocephalus and sex 7 , 20 . Therefore, whether sex is associated with more severe neurologic complications remains controversial. Our results also show that there is no correlation between hydrocephalus and sex. Serious clinical presentations, manifested as encephalopyosis and seizures, are the strong prognostic factors for hydrocephalus in children 11 , 21 . Our results agreed, showing that encephalopyosis and seizures were risk factors for HBM. Few previous studies have investigated CSF parameters in children and adults with hydrocephalus in BM, and suggested that elevated CSF protein and WBCs were risk factors for hydrocephalus 13 , 22, 23 . However, there is a major drawback in these studies there were variations in CSF examination. To overcome this shortcoming, we evaluated the characteristics of CSF parameters in different periods and then assessed their predictive values for hydrocephalus. Some experts recommend that all infants with bacterial meningitis undergo repeat LP 5–7 days after initiation of therapy 24 , 25 . Greenberg et al. reported the presence of a positive culture in a repeat CSF was associated with increased mortality 26 . The prevoious study suggested that high WBC on the second CSF sample was predictive of adverse outcomes at the time of discharge from the hospital. The multivariate regression analysis showed that cerebrospinal fluid protein > 2g/L and CSF leukocytes > 100×10^6/L were risk factors for hydrocephalus in this study. It is important for a pediatrician to perform accurate evaluation, achieve early identification, and provide aggressive critical care interventions for these children. In earlier studies, hydrocephalus in BM had been found a determinant of poor outcome and mortality [9, 11]. Chen et al found that the sequelae rate of 67 children with hydrocephalus in BM was 68.7%, including secondary epilepsy (6%) [13]. We also found that a higher rate of secondary epilepsy, hearing impairment, and death in the hydrocephalus group. This study has some limitations. A major limitation of our work is that it was a single-center, retrospective, nonrandomized study, which could lead to information bias. Second, the sample size was relatively small. Third, the span of follow-up and the evaluated ways of neurobehavioral development were limited. These suggest that long-term, largescale studies are needed to take the progressive trajectories and longer follow-up of the neurobehavioral development to reduce adverse perinatal complications. In conclusion, our study presents novel information, not previously reported, as we considered the CSF results of repeat LP within the first 5–7 days was very important, and could be identified as predictive factors for HBM. Fever was the most common symptom of HBM. Neonates with HBM been found a higher rate of secondary epilepsy, hearing impairment, and death. Therefore, these findings are helpful for clinicians to design more accurate treatment programs and follow-up programs for neonates with HBM. Declarations Acknowledgements The authors thank the families for their kind cooperation and enthusiastic participation in this study, and Tingting Cheng (Guangzhou Women and Children's Medical Center) for performing the statistical analyses. Funding This work was supported by the Clinical Research Special Funding of Wu Jieping Medical Foundation (Grant No.320. 6750.2023-24-13), Sanming Project of Medicine in Shenzhen Guangming (szgmtd2025001), and Guangdong Medical Science and Technology Research Fund (Grant No.A2024102). Competing interests The author has no competing interests to declare that are relevant to the content of this article. Ethics approval and consent to participate This study was conducted with approval from Research Ethics Committee of Changsha Hospital for Maternal and Child Health Care (No. 202515), The First Affiliated Hospital of Guangzhou University of Chinese Medicine (No.K-2025-049), Guangming District People's Hospital (No. LL-KT-Y-2025080), and Guangzhou Women and Children's Medical Center(No.2022022217162412). This study was conducted in accordance with the declaration of Helsinki. The patients/participants provided their written informed consent to participate in this study. Written informed consent was obtained from the individual(s), and minor(s)’ legal guardian/next of kin. Data availability The datasets analyzed during the current study are available from the corresponding author upon reasonable request. Author Contributions W.Y contributed in conception, search, statistical analyses, data interpretation and manuscript drafting. J.C contributed in design and data interpretation.M.S contributed in design data. J.X contributed in conception, design, statistical analyses and supervised the study. J.L and G.L contributed in supervised the study. M. H contributed in edit the study. All authors approved the final manuscript for submission. References Tavares, T., Pinho, L., & Bonifácio Andrade, E. Group B Streptococcal Neonatal Meningitis. Clin Microbiol Rev . 35 , e0007921(2022). https://doi.org/10.1128/cmr.00079-21 Mayhew, J. A., & Alali, M. Neonatal Bacterial Meningitis: What Have We Learned From the Last Decade?. Pediatric annals. 53 , e425–e432 (2024) . https://doi.org/10.3928/19382359-20240908-07 Ouchenir, L., et al. The Epidemiology, Management, and Outcomes of Bacterial Meningitis in Infants. Pediatrics. 140, e20170476 (2017) . https://doi.org/10.1542/peds.2017-0476 Moore, M., Fitzgibbons, E. J., Driscoll, C., & Beswick, R. 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Ann Med. 53, 2199-2204 (2021). https://doi.org/10.1080/07853890.2021.2004318 Ting, J. Y., et al . Predictive value of repeated cerebrospinal fluid parameters in the outcomes of bacterial meningitis in infants <90 days of age. Plos One. 15, e0238056 (2020). https://doi.org/10.1371/journal.pone.0238056 Agarwal, R., & Emmerson, A. J. Should repeat lumbar punctures be routinely done in neonates with bacterial meningitis?. Results of a survey into clinical practice. Arch Dis Child. 84, 451-2 (2001).https://doi.org/10.1136/adc.84.5.450d Greenberg, R. G., et al. Repeat lumbar punctures in infants with meningitis in the neonatal intensive care unit. J Perinatol. 31, 425-9 (2011). https://doi.org/10.1038/jp.2010.142 Tables Table 1. Baseline characteristics in neonates with and without hydrocephalus in bacterial meningitis(n =227). Characteristics Without hydrocephalus(n=154) With hydrocephalus(n=73) P - value GA at birth , mean(SD), weeks 38.4(2.2） 37.8(2.4） 0.03 Female, n (%) 50(32.5) 25(34.2) 0.79 Vaginal delivery, n (%) 107(69.5) 50(68.5) 0.88 Birth weight, mean(SD), grams, 2997.2(575.2） 3014.0(575.6） 0.42 Day of onset, mean(SD), days 15.7(11.0） 18.9(15.1） 0.11 Fever,n (%) 148(96.1） 65(89.0） 0.04 Convulsion at onset, n (%) 24(15.6） 23(31.5） 0.006 Altered consciousness, n (%) 16(10.4） 24(32.9） <0.001 Positive bacterial culture, n (%) 100(64.9） 63(86.3） 100mg/L, n (%) 56(36.36） 52(71.2） <0.001 Subdural effusion, n(%) 31(20.1) 21(28.8) 0.15 Encephalopyosis, n(%) 1(0.6) 15(20.5) <0.001 Ependymitis, n(%) 2(1.3) 19(26.0) <0.001 Abbreviations: CRP, C-reactive protein; GA，gestational age; n, number; SD, standard deviations. Table 2. The etiology of CSF culture in the 227 neonates. Bacterias With hydrocephalus(n=73) Without hydrocephalus(n=154) Total 63 100 Escherichia coli , n (%) 23(36.5%) 33(33%) Group B streptococcus , n (%) 19(30.2%) 43(43%) Streptococcus pneumoniae , n (%) 6(9.5%) 5(5%) Klebsiella aerogenes, n (%) 2(3.2%) 2(2%) Lizabethkingia meningosepticum , n (%) 4(6.3%) 1(1%) Serratia marcescens , n (%) 2(3.2%) 0 Streptococcus gallolyticus , n (%) 1(1.6%) 3(3%) Staphylococcus aureus , n (%) 1(1.6%) 4(4%) Acinetobacter baumannii , n (%) 0 2(2%) Enterococcus faecium , n (%) 0 3(3%) Others, n (%) 5(7.9%) 4(4%) Table 3. The CSF characteristics of bacteria meningitis with and without hydrocephalus (n =227). Characteristics Without hydrocephalus (n=154) With hydrocephalus(n=73) P- value First lumbar puncture Whole CSF WBC median(range),10^6/L 613(17-53710） 2451(82-38426） <0.001 Glucose mean(SD), mmol/L 1.73(1.02） 0.89(1.08） <0.001 Chloride, mean (SD), mmol/L 119.67(5.84） 117.38(23.32） 0.27 Protein, mean(SD), g/L 2.21(1.59） 4.37(4.48） <0.001 Second lumbar puncture Whole CSF WBC median(range),10^6/L 118(2-44710） 736.5(12-68637） <0.001 Glucose, mean(SD), mmol/L 1.85(0.64） 1.17(1.13） <0.001 Chloride, mean(SD), mmol/L 122.28(4.14） 117.86(7.22） <0.001 Protein, mean(SD), g/L 1.65(0.99） 4.14(2.89） <0.001 Third lumbar puncture Whole CSF WBC, median (range), 10^6/L 27.5(1-628） 120(1.75-13433） <0.001 Glucose, mean(SD), mmol/L 2.18(0.92） 1.58(0.93） <0.001 Chloride, mean(SD), mmol/L 122.77(3.45） 120.86(7.57） 0.03 Protein, mean(SD), g/L 1.67(2.89） 4.21(5.10） <0.001 Abbreviations: CSF: cerebrospinal fluid; n, number; SD, standard deviations; WBC: white blood cell count. Table 4. Univariate and multivariate analysis of risk factors for hydrocephalus in bacterial meningitis. Potentially relevant factor Univariate analysis Multivariate analysis P - value OR (95% CI) P - value OR (95% CI) Female 0.79 0.92[0.51-1.66] 0.712 0.83[0.31-2.25] GA at birth 0.07 0.90[0.73-1.01] 0.247 0.88[0.70-1.10] Convulsion at onset 0.003 2.65[1.38-5.10] 0.03 3.47[1.13-10.66] CRP >100mg/L 5000*10^6/L <0.001 3.50[1.80-6.81] 0.028 3.34[1.14-9.80] Initial CSF glucose <1.1 mmol/L 4g/L 500*10^6/L <0.001 9.14[5.02-18.53] 0.006 4.55[1.55-13.34] Second CSF glucose <1.1 mmol/L <0.001 13.55[6.60-27.81] 4g/L 100*10^6/L 4g/L <0.001 9.96[3.81-26.04] 0.19 0.29[0.04-1.86] encephalopyosis <0.001 53.83[7.04-411.81] 0.001 48.47[4.51-520.46] Abbreviations: CRP, C-reactive protein; CSF: cerebrospinal fluid; GA, gestational age; n, number; WBC: white blood cell count. Table 5. Predictive value of second CSF parameters for hydrocephalus in bacterial meningitis. Parameter AUC 95% CI Cut-off Sensitivity Specificity Youden index a 2nd CSF WBC(10^6/L) 0.820 [0.761-0.879] 204.5 0.824 0.691 0.515 2nd CSF Glucose (mmol/L) 0.753 [0.673-0.833] 1.24 0.618 0.845 0.463 2nd CSF protein (mmol/L) 0.818 [0.758-0.879] 1.53 0.912 0.583 0.495 Abbreviations: AUC: area under the curve ; CI: confidence Interval; CSF: cerebrospinal fluid; a Youden index= sensitivity+specificity-1 Table 6. Neurological outcomes of patients with hydrocephalus versus without hydrocephalus. Characteristics Without hydrocephalus(n=154) With hydrocephalus(n=73) p - value Ommaya reservoir, n (%) NA 36(49.3) NA Permanent shunt, n (%) NA 25(34.2) NA Follow-up Secondary epilepsy, n(%) 6(3.9) 27((37.0) <0.001 Hearing impairment, n (%) 24(15.6) 39(53.4) <0.001 Encephalomalacia, n(%) 7(4.5) 29(39.7) <0.001 Death, n (%) 1(0.6) 6(8.2) <0.001 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 01 May, 2026 Read the published version in Scientific Reports → Version 1 posted Editorial decision: Revision requested 01 Dec, 2025 Reviews received at journal 30 Nov, 2025 Reviews received at journal 29 Nov, 2025 Reviewers agreed at journal 12 Nov, 2025 Reviewers agreed at journal 09 Nov, 2025 Reviewers invited by journal 07 Nov, 2025 Editor invited by journal 24 Oct, 2025 Editor assigned by journal 13 Oct, 2025 Submission checks completed at journal 13 Oct, 2025 First submitted to journal 12 Oct, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Care","correspondingAuthor":false,"prefix":"","firstName":"Ju","middleName":"","lastName":"LI","suffix":""},{"id":546055463,"identity":"82ce0dfa-8aee-4795-9cf6-6ae2223380e6","order_by":2,"name":"Guohui Lu","email":"","orcid":"","institution":"Guangzhou Women and Children's Medical Center","correspondingAuthor":false,"prefix":"","firstName":"Guohui","middleName":"","lastName":"Lu","suffix":""},{"id":546055464,"identity":"68bac9b0-d905-4bc8-aa69-ad225cc45783","order_by":3,"name":"Meiling Huang","email":"","orcid":"","institution":"Guangzhou Women and Children's Medical Center","correspondingAuthor":false,"prefix":"","firstName":"Meiling","middleName":"","lastName":"Huang","suffix":""},{"id":546055465,"identity":"71ab69d1-b8db-40f7-b259-407feb7ea730","order_by":4,"name":"juncao Chen","email":"","orcid":"","institution":"Shenzhen Guangming District People's Hospital","correspondingAuthor":false,"prefix":"","firstName":"juncao","middleName":"","lastName":"Chen","suffix":""},{"id":546055466,"identity":"8945b104-87bd-439a-986d-1a9bcdab21fc","order_by":5,"name":"Weiming Yuan","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA1klEQVRIiWNgGAWjYBACNihtxy//+MCBDz9I0JIs2ZCWeHBmDwm2MW44kGN8mIONsEoGPvbTadI8NXeYDQ6c+XCYgYdBnl/sAAGH8eRuk+Y59oxP8mDvhsMFFgyGM2cnENDCANLCdpiZ7zDvhsMzeBgSDG4T0sL/Fqjl32HGhmM8Dw7zsBGjRQJoC2/bYcYJZ3gYiNXydrPl3L7DyZIz2AyAgSxB2C/y/bkbb7z5dtiOX4L58YcPP2zk+aUJaAECFgkkjgROZciA+QNRykbBKBgFo2DkAgDZz0Vm+M2YOwAAAABJRU5ErkJggg==","orcid":"","institution":"The First Affiliated Hospital of Guangzhou University of Chinese Medicine","correspondingAuthor":true,"prefix":"","firstName":"Weiming","middleName":"","lastName":"Yuan","suffix":""}],"badges":[],"createdAt":"2025-10-12 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16:02:24","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":422666,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7841321/v1/44ec9acd-f5ca-4fb5-a5a2-54aad4b19224.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Clinical Features, Outcomes, Predictive Factors and Prognosis of Hydrocephalus in Neonatal Bacterial Meningitis: A Prospective Case-Control Study","fulltext":[{"header":"Introduction","content":"\u003cp\u003eOf all age categories, infants have the highest prevalence of bacterial meningitis (BM), which significantly increases infant mortality and morbidity globally \u003csup\u003e\u003cspan additionalcitationids=\"CR2\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e. According to population-based studies, up to 24% of patients who survive bacterial meningitis experience neurological sequelae\u003csup\u003e\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e.These neurologic complications include hydrocephalus, subdural effusions or empyemas, sensorineural hearing loss, seizures, motor disorders, mental retardation, and behavioral problems \u003csup\u003e\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e\u003cp\u003eThe most common complication of BM is hydrocephalus, some studies demonstrated that the prevalence of hydrocephalus in BM (HBM) ranged from 9.36% to 34% \u003csup\u003e7\u0026ndash;9\u003c/sup\u003e. A few studies have discussed the clinical characteristics of HBM in childhood \u003csup\u003e\u003cspan additionalcitationids=\"CR11\" citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e. However, information about clinical characteristics and prognostic variables for neonates with hydrocephalus in BM is lacking \u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e,\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e. Moreover, in most of these studies, many children still die or suffer significant neurological sequelae because there is presently no effective medication treatment. Therefore, finding clinical features, and risk factors for this encephalopathy represents an important and urgent need. In this study, we reported on: (1) the clinical features of hydrocephalus and other neurologic complications that occured after BM; (2) the causative pathogens, the process of cerebrospinal fluid (CSF) parameters, and risk factors for HBM; and (3) the long-term outcomes of HBM.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e\u003cstrong\u003eStudy Design\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eInfants admitted to hospitals between September 2018 and March 2024 were included in this prospective case-control research. The study protocols were approved by the research ethical committee of hospitals.\u0026nbsp;All families gave consent to the participate.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStudy Sample\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe neonates were categorized into two groups: the BM group, and neonates with HBM (HBM group). All infants underwent routine lumbar puncture (LP), complete regular follow-up for a minimum of 6 months and a maximum of 2 years.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAll patients underwent head magnetic resonance imaging (MRI) examination.\u0026nbsp;The neonatal BM was diagnosed if met any criterion of the following: (I) positive CSF culture; or (II) CSF pleocytosis (white blood cells [WBC] \u0026ge; 20/mm\u003csup\u003e3\u003c/sup\u003e ) with a predominance of polymorphonucleocytes (\u0026gt;50%), CSF glucose \u0026lt; 2.2 mmol/L or CSF glucose 40% lower than normal blood glucose level, and CSF protein is greater than 1.5g/L. For infants with traumatic lumbar punctures (ie, CSF RBC count 10 000 cells per mm\u003csup\u003e3\u003c/sup\u003e ), we used an red blood cells (RBC)/WBC correction factor of 1000:1 to determine the corrected CSF WBC count. Hydrocephalus could be diagnosed according to any of the following criteria: third ventricular diameter \u0026gt; 6 mm; fourth ventricular diameter \u0026gt; 12 mm; maximum frontal horn diameter \u0026gt; 45 mm; Evan index (maximum frontal horn diameter divided by maximum cranial diameter in that plane) \u0026gt; 0.3. The following were the criteria for exclusion: 1) the onset age of a full-term infant was greater than 28 days, and the corrected gestational age of a preterm infant was more than 44 weeks; 2) genetic syndromes, or chromosomal abnormalities; 3)previous nerve system procedures (e.g., myelomeningocele closure, ventriculoperitonieal shunts); 4) cerebral hemorrhages; 5) infection of the central nervous system that is not caused by bacteria.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Collection\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFor each included neonate, we abstracted historical, physical examination, and laboratory data, including results of\u0026nbsp;the initial\u0026nbsp;CSF profile\u0026nbsp;for diagnostic purposes in patients with suspected BM\u0026nbsp;(ie, WBC count, and protein and glucose levels), and CSF bacterial cultures; we also included the CSF profile of repeat\u0026nbsp;LP that had\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003ebeen done 5\u0026ndash;7 and 15-20 days after the initial\u0026nbsp;lumbar puncture.\u003c/p\u003e\n\u003cp\u003eWe defined an adverse outcome as any of the following occurring a minimum of 6 months and a maximum of 2 years: death; neurologic sequelae (defined as hearing loss, seizures, or any abnormal cranial imaging). Epilepsy was characterized by an enduring predisposition for epileptic seizures, diagnosed by electroencephalography (EEG). Hearing impairment was measured by automated auditory brainstem response (AABR) and otoacoustic emission (OAE) tests which were the best methods of hearing assessment among diagnostic methods because of their specificity and sensitivity. A supervisor and a trained clerk entered the data. The co-author double-checked the data for mistakes and inconsistencies. \u0026nbsp; \u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eStatistical Analysis\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eStatistical analysis was performed using SPSS Statistics version 26.0 (SPSS Inc., Chicago, Illinois, USA). Means (standard deviations [SD]) or median (range) was used to describe continuous variables; \u003cem\u003et-\u003c/em\u003etests, or mann-whitney \u0026mu; test were used to analyze the differences in continuous variables. A two-sided chi-squared or Fisher\u0026apos;s exact test was used for categorical variables presented as numbers and percentages. To identify risk factors for hydrocephalus in BM, univariate and multivariate regression analyses were used. A receiver operating characteristic (ROC) curve was used to determine the best cut-off value for diagnosis. Statistical significance was set at \u003cem\u003eP\u003c/em\u003e \u0026lt;0.05.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e\u003cstrong\u003eBaseline characteristics\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eRelevant characteristics of infants with HBM were presented in Table 1.\u0026nbsp;Over the 6 years, a total of 227 neonates who met the inclusion criteria were enrolled in the study cohort, of which 73 neonates with hydrocephalus. There was no significant difference between patients with and without hydrocephalus in sex, the type of delivery, birth weight, and days of onset. The clinical manifestations of HBM often lack specificity, and fever (n=65) was the most common symptom.\u0026nbsp;MRI was completed in all cases.\u0026nbsp;Of the 73 neonates\u0026nbsp;with HBM, 25 cases (34.2%, 25/73) had 2 or more abnormalities complications, including\u0026nbsp;subdural effusion (21, 28.8%),\u0026nbsp;encephalopyosis (15, 20.5%) and ependymitis (19, 26.0%).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 2 summarized the pathogens of BM with and without hydrocephalus. \u003cstrong\u003eT\u003c/strong\u003ehe positive rate of CSF culture in patients with hydrocephalus was higher than that of neonates without hydrocephalus (63/73, 86.3%). In this study, the most common pathogens in patients with HBM were\u0026nbsp;\u003cem\u003eEscherichia coli\u0026nbsp;\u003c/em\u003e(23/63, 36.5%),\u0026nbsp;\u003cem\u003eGroup B streptococcus\u003c/em\u003e (19/63, 30.2%), and \u003cem\u003eS\u003c/em\u003e\u003cem\u003etreptococcus pneumoniae\u003c/em\u003e (6/63, 9.5%).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCharacteristics of CSF\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTable 3 compared CSF parameters between neonates with or without hydrocephalus. At the first CSF examination after the onset of meningitis, the CSF of\u0026nbsp;hydrocephalus\u0026nbsp;group had the higher WBC counts (median, 2451\u0026times;10^6/L; range, 82-38426\u0026times;10^6/L) and protein levels (mean, 4.37g/L; standard deviations (SD), 4.48 g/L), while had considerably lower level of glucose (mean, 0.89 mmol/L; SD, 1.08 mmol/L\u0026nbsp;), when compared to that in BM groups (all \u003cem\u003eP\u003c/em\u003e \u0026lt; 0.05).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eOf these 227 cases, 217 neonates underwent repeat LP within the first 5-7 days. CSF WBC counts\u0026nbsp;(median,736.5 \u0026times;10^6/L; range, 12-68637 \u0026times;10^6/L) and\u0026nbsp;protein levels\u0026nbsp;(mean, 4.14g/L; SD, 2.89g/L)\u0026nbsp;were significantly higher in patients with hydrocephalus; in addition, the\u0026nbsp;glucose (mean,1.17mmol/l; SD, 1.13mmol/l )\u0026nbsp;and CSF chloride\u0026nbsp;levels\u0026nbsp;(mean,117.86mmol/l; SD, 7.22mmol/l ) were lower in hydrocephalus group.\u003c/p\u003e\n\u003cp\u003e216 neonates underwent repeat LP at two weeks after the onset of meningitis. The CSF WBC of 72 patients without hydrocephalus had returned to normal during this period, but the CSF WBC of the hydrocephalus group was still significantly increased.\u0026nbsp;Significant differences were found in\u0026nbsp;CSF WBC\u0026nbsp;counts, protein,\u0026nbsp;glucose and chloride\u0026nbsp;levels\u0026nbsp;between two groups\u0026nbsp;(all \u003cem\u003eP\u003c/em\u003e \u0026lt; 0.05).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePredictors of hydrocephalus\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eBased on the results from Tables 4; on univariate analysis, risk factors associated with hydrocephalus were encephalopyosis (\u003cem\u003eP\u003c/em\u003e\u0026lt;0.001),\u0026nbsp;second\u0026nbsp;CSF protein \u0026gt; 4g/L (\u003cem\u003eP\u0026nbsp;\u003c/em\u003e\u0026lt;0.001)，second\u0026nbsp;CSF glucose \u0026lt;1.1 mmol/L (\u003cem\u003eP\u003c/em\u003e\u0026lt;0.001), third\u0026nbsp;CSF protein \u0026gt; 4g/L (\u003cem\u003eP\u0026nbsp;\u003c/em\u003e\u0026lt;0.001), second CSF WBC\u0026nbsp;\u0026gt;500\u0026times;10^6/L (\u003cem\u003eP\u003c/em\u003e\u0026lt;0.001), initial CSF protein \u0026gt; 4g/L (\u003cem\u003eP\u003c/em\u003e\u0026lt;0.001), initial CSF glucose \u0026lt;1.1 mmol/L (\u003cem\u003eP\u003c/em\u003e\u0026lt;0.001), C-reactive protein (CRP) \u0026gt;100mg/L (\u003cem\u003eP\u003c/em\u003e\u0026lt;0.001), initial CSF WBC\u0026gt;5000\u0026times;10^6/L (\u003cem\u003eP\u0026nbsp;\u003c/em\u003e\u0026lt;0.001), positive bacterial culture(\u003cem\u003eP=\u003c/em\u003e0.002),\u0026nbsp;and convulsion at onset(\u003cem\u003eP=\u003c/em\u003e0.003).\u0026nbsp;Next, multivariate logistic regression was used to analyze the clinical parameters identified as significant in predicting hydrocephalus from the univariate analysis. The following parameters were identified as independent predictive factors for hydrocephalus in neonatal BM:\u0026nbsp;encephalopyosis\u0026nbsp;(\u003cem\u003eP\u003c/em\u003e\u0026lt;0.001,\u0026nbsp;OR (95%\u0026nbsp;confidence Interval [CI])\u0026nbsp;48.47 [4.51-520.46]), second\u0026nbsp;CSF glucose \u0026lt;1.1 mmol/L (\u003cem\u003eP\u003c/em\u003e\u0026lt;0.001,\u0026nbsp;OR (95% CI)\u0026nbsp;6.35 [2.17-18.55]), second\u0026nbsp;CSF protein \u0026gt; 4g/L (\u003cem\u003eP=\u003c/em\u003e0.001,\u0026nbsp;OR (95% CI)\u0026nbsp;12.34[2.72-56.05]),\u0026nbsp;CRP \u0026gt;100mg/L (\u003cem\u003eP=\u003c/em\u003e0.008,\u0026nbsp;OR (95% CI)\u0026nbsp;3.72[1.41-9.78]), third CSF WBC\u0026nbsp;\u0026gt;100\u0026times;10^6/L (\u003cem\u003eP=\u003c/em\u003e0.016,\u0026nbsp;OR (95% CI)3.33[1.25-8.86]), convulsion at onset(\u003cem\u003eP=\u003c/em\u003e0.03,\u0026nbsp;OR (95% CI)\u0026nbsp;3.47[1.13-10.66]),\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eand \u003cstrong\u003ei\u003c/strong\u003enitial CSF WBC\u0026nbsp;\u0026gt;5000\u0026times;10^6/L (\u003cem\u003eP=\u003c/em\u003e0.028,\u0026nbsp;OR (95% CI)\u0026nbsp;3.34 [1.14-9.80]).\u0026nbsp;These findings suggested that the CSF results of repeat LP within the first 5-7 days was very important, and could be identified as predictive factors for hydrocephalus in neonatal BM.\u003c/p\u003e\n\u003cp\u003eNext, a ROC curve was used to evaluate the predictive value of second CSF characteristic for hydrocephalus;\u0026nbsp;results were shown in Table 5. CSF\u0026nbsp;WBC on the second LP yielded an area under the curve (AUC) of 0.820 (95% CI, 0.761\u0026minus;0.879; \u003cem\u003eP\u0026nbsp;\u003c/em\u003e\u0026lt;\u0026nbsp;0.001) for predicting sequelae at discharge from hospital, with a cut-off value of 204.5 \u0026times; 10^6 /L, providing a sensitivity of 82.4% and specificity of 69.1%.\u0026nbsp;In addition,\u0026nbsp;second\u0026nbsp;CSF glucose\u0026nbsp;(the area under the ROC curve = 0.753; 95% confidence interval:\u0026nbsp;0.673-0.833)\u0026nbsp;and protein level (\u0026nbsp;the area under the ROC curve = 0.818; 95% confidence interval:\u0026nbsp;0.758-0.879)\u0026nbsp;also had predictive value for hydrocephalus.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFollow up\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eFollow-up of the subjects comprised a minimum of 6 months and a maximum of 2 years, and the outcomes of the infants were summarized in Table 6. Although the majority of\u0026nbsp;neonates\u0026nbsp;with\u0026nbsp;hydrocephalus were given\u0026nbsp;undergone surgical treatment; the rate of secondary epilepsy\u0026nbsp;(37% \u003cem\u003evs.\u0026nbsp;\u003c/em\u003e3.9%), hearing impairment (53.4% \u003cem\u003evs.\u003c/em\u003e 15.6%),\u0026nbsp;encephalomalacia (39.7%\u003cem\u003evs.\u0026nbsp;\u003c/em\u003e4.5%),\u0026nbsp;and death (8.2% \u003cem\u003evs.\u0026nbsp;\u003c/em\u003e0.6%) in the\u0026nbsp;hydrocephalus group were\u0026nbsp;significantly\u0026nbsp;higher than\u0026nbsp;that in the BM\u0026nbsp;group(all \u003cem\u003eP\u003c/em\u003e \u0026lt; 0.001).\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eWe conducted a case-control study to explore the clinical features of HBM in neonates. The main results of our study suggested the following:1) fever was the most common symptom in patients; \u003cem\u003eEscherichia coli\u003c/em\u003e and \u003cem\u003eGroup B streptococcus\u003c/em\u003e were the most common causative pathogens causing hydrocephalus; 2) the CSF results of repeat LP within the first 5\u0026ndash;7 days was very important, could be identified as predictive factors for HBM. 3) patients with hydrocephalus were more vulnerable to adverse outcomes.\u003c/p\u003e\u003cp\u003eThe utility of CSF parameters in diagnosing BM in infants is well-recognized, and endorsed by clinicians as the primary diagnostic approach \u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e,\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e. Classically, BM is characterized by elevated CSF protein, WBCs, and decreased CSF glucose. Growing evidence suggests that intraventricular hemorrhage (IVH), and resultant post-hemorrhagic hydrocephalus (PHH) presented host-immune responses, then altered the CSF profile; the altered characteristics of CSF in IVH and PHH similar to those in BM \u003csup\u003e17\u003c/sup\u003e. When CSF culture is negative, BM and PHH are easily confused. So some neonates with IVH or PHH were misdignosed as BM or hydrocephalus in BM in earlier studies \u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u003c/sup\u003e. Therefore, we excluded neonates with concomitant IVH in our study.\u003c/p\u003e\u003cp\u003eDespite some clinical factors demonstrating an association with hydrocephalus in adults and children, the risk factors contributing to hydrocephalus in neonatal meningitis have scantly been evaluated. The previous study showed that female sex was a predictor for hydrocephalus \u003csup\u003e\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003e; other studies show that there was no correlation between the development of hydrocephalus and sex\u003csup\u003e\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, 20\u003c/sup\u003e. Therefore, whether sex is associated with more severe neurologic complications remains controversial. Our results also show that there is no correlation between hydrocephalus and sex. Serious clinical presentations, manifested as encephalopyosis and seizures, are the strong prognostic factors for hydrocephalus in children \u003csup\u003e\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e. Our results agreed, showing that encephalopyosis and seizures were risk factors for HBM.\u003c/p\u003e\u003cp\u003eFew previous studies have investigated CSF parameters in children and adults with hydrocephalus in BM, and suggested that elevated CSF protein and WBCs were risk factors for hydrocephalus \u003csup\u003e\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e, 22, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u003c/sup\u003e. However, there is a major drawback in these studies there were variations in CSF examination. To overcome this shortcoming, we evaluated the characteristics of CSF parameters in different periods and then assessed their predictive values for hydrocephalus. Some experts recommend that all infants with bacterial meningitis undergo repeat LP 5\u0026ndash;7 days after initiation of therapy \u003csup\u003e\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u003c/sup\u003e. Greenberg et al. reported the presence of a positive culture in a repeat CSF was associated with increased mortality \u003csup\u003e\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u003c/sup\u003e. The prevoious study suggested that high WBC on the second CSF sample was predictive of adverse outcomes at the time of discharge from the hospital. The multivariate regression analysis showed that cerebrospinal fluid protein\u0026thinsp;\u0026gt;\u0026thinsp;2g/L and CSF leukocytes\u0026thinsp;\u0026gt;\u0026thinsp;100\u0026times;10^6/L were risk factors for hydrocephalus in this study. It is important for a pediatrician to perform accurate evaluation, achieve early identification, and provide aggressive critical care interventions for these children.\u003c/p\u003e\u003cp\u003eIn earlier studies, hydrocephalus in BM had been found a determinant of poor outcome and mortality [9, 11]. Chen et al found that the sequelae rate of 67 children with hydrocephalus in BM was 68.7%, including secondary epilepsy (6%) [13]. We also found that a higher rate of secondary epilepsy, hearing impairment, and death in the hydrocephalus group.\u003c/p\u003e\u003cp\u003eThis study has some limitations. A major limitation of our work is that it was a single-center, retrospective, nonrandomized study, which could lead to information bias. Second, the sample size was relatively small. Third, the span of follow-up and the evaluated ways of neurobehavioral development were limited. These suggest that long-term, largescale studies are needed to take the progressive trajectories and longer follow-up of the neurobehavioral development to reduce adverse perinatal complications.\u003c/p\u003e\u003cp\u003eIn conclusion, our study presents novel information, not previously reported, as we considered the CSF results of repeat LP within the first 5\u0026ndash;7 days was very important, and could be identified as predictive factors for HBM. Fever was the most common symptom of HBM. Neonates with HBM been found a higher rate of secondary epilepsy, hearing impairment, and death. Therefore, these findings are helpful for clinicians to design more accurate treatment programs and follow-up programs for neonates with HBM.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors thank the families for their kind cooperation and enthusiastic participation in this study, and Tingting Cheng (Guangzhou Women and Children\u0026apos;s Medical Center) for performing the statistical analyses.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003eThis work was supported by the Clinical Research Special Funding of Wu Jieping Medical Foundation (Grant No.320. 6750.2023-24-13), Sanming Project of Medicine in Shenzhen Guangming (szgmtd2025001), and Guangdong Medical Science and Technology Research Fund (Grant No.A2024102).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u0026nbsp;\u003c/strong\u003eThe author has no competing interests to declare that are relevant to the content of this article.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was conducted with approval from Research Ethics Committee of\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eChangsha Hospital for Maternal and Child Health Care (No. 202515), The First\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAffiliated Hospital of Guangzhou University of Chinese Medicine (No.K-2025-049), Guangming District People\u0026apos;s Hospital (No. LL-KT-Y-2025080), and Guangzhou Women and Children\u0026apos;s Medical Center(No.2022022217162412). This study was conducted in accordance with the declaration of Helsinki. The patients/participants provided their written informed consent to participate in this study. Written informed consent was obtained from the individual(s), and minor(s)\u0026rsquo; legal guardian/next of kin.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets analyzed during the current study are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eW.Y contributed in conception, search, statistical analyses, data interpretation and manuscript drafting. J.C contributed in design and data interpretation.M.S contributed in design data. J.X contributed in conception, design, statistical analyses and supervised the study. J.L and G.L contributed in supervised the study. M. H\u003c/p\u003e\n\u003cp\u003econtributed in edit the study. All authors approved the final manuscript for submission.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eTavares, T., Pinho, L., \u0026amp; Bonif\u0026aacute;cio Andrade, E. Group B Streptococcal Neonatal Meningitis. \u003cem\u003eClin Microbiol Rev\u003c/em\u003e. \u003cstrong\u003e\u003cem\u003e35\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e,\u003c/strong\u003e e0007921(2022). https://doi.org/10.1128/cmr.00079-21\u003c/li\u003e\n\u003cli\u003eMayhew, J. A., \u0026amp; Alali, M. Neonatal Bacterial Meningitis: What Have We Learned From the Last Decade?. \u003cem\u003ePediatric annals.\u003c/em\u003e\u003cstrong\u003e\u003cem\u003e53\u003c/em\u003e\u003c/strong\u003e, e425\u0026ndash;e432 (2024) . https://doi.org/10.3928/19382359-20240908-07\u003c/li\u003e\n\u003cli\u003eOuchenir, L., et al. 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Hydrocephalus is a rare outcome in community-acquired bacterial meningitis in adults: a retrospective analysis. \u003cem\u003eBMC Infect Dis.\u003c/em\u003e\u003cstrong\u003e 13\u003c/strong\u003e, 321 (2013). https://doi.org/10.1186/1471-2334-13-321\u003c/li\u003e\n\u003cli\u003eMorton, S. U.,et al. Paenibacillus spp infection among infants with postinfectious hydrocephalus in Uganda: an observational case-control study. \u003cem\u003eLancet Microbe. \u003cstrong\u003e4, \u003c/strong\u003e\u003c/em\u003ee576 (2023). https://doi.org/10.1016/S2666-5247(23)00106-4\u003c/li\u003e\n\u003cli\u003eHuo, L., Fan, Y., Jiang, C., Gao, J., Yin, M., Wang, H., Yang, F., \u0026amp; Cao, Q. Clinical Features of and Risk Factors for Hydrocephalus in Childhood Bacterial Meningitis.\u003cem\u003eJ Child Neurol.\u003c/em\u003e\u003cstrong\u003e34,\u003c/strong\u003e 11-16 (2019).https://doi.org/10.1177/0883073818799155\u003c/li\u003e\n\u003cli\u003eMactier, H., Galea, P., \u0026amp; McWilliam, R. Acute obstructive hydrocephalus complicating bacterial meningitis in childhood. \u003cem\u003eBMJ. \u003c/em\u003e\u003cstrong\u003e316, \u003c/strong\u003e1887-1889 (1998). https://doi.org/10.1136/bmj.316.7148.1887\u003c/li\u003e\n\u003cli\u003eChen, B., Zhai, Q., Ooi, K., Cao, Y., \u0026amp; Qiao, Z.Risk factors for hydrocephalus in neonatal purulent meningitis: A single-center retrospective analysis.\u003cem\u003e \u003c/em\u003e\u003cem\u003eJ Child Neurol. \u003c/em\u003e\u003cstrong\u003e36,\u003c/strong\u003e 491-497(2021). https://doi.org/10.1177/0883073820978032\u003c/li\u003e\n\u003cli\u003eChen, J., \u003cem\u003eet al\u003c/em\u003e . Quantitative proteomics on the cerebrospinal fluid of hydrocephalus in neonatal bacterial meningitis. \u003cem\u003eFront Pediatr\u003c/em\u003e.\u003cstrong\u003e10, \u003c/strong\u003e972032(2022).https://doi.org/10.3389/fped.2022.972032\u003c/li\u003e\n\u003cli\u003eShahan, B., Choi, E. Y., \u0026amp; Nieves, G. 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Outcomes and prognostic factors of infantile acquired hydrocephalus: a single-center experience. \u003cem\u003eBMC Pediatr.\u003c/em\u003e\u003cstrong\u003e23, \u003c/strong\u003e260 (2023). https://doi.org/10.1186/s12887-023-04034-w\u003c/li\u003e\n\u003cli\u003eBloch, D.,\u003cem\u003eet al\u003c/em\u003e . Sex difference in meningococcal disease mortality, New York City, 2008-2016. \u003cem\u003eClin Infect Dis.\u003c/em\u003e\u003cstrong\u003e67, \u003c/strong\u003e760-769(2018). https://doi.org/10.1093/cid/ciy183\u003c/li\u003e\n\u003cli\u003ePaliwal, V. K., \u0026amp; Garg, R. K. Hydrocephalus in tuberculous meningitis - Pearls and Nuances. \u003cem\u003eNeurol India.\u003c/em\u003e\u003cstrong\u003e69,\u003c/strong\u003e S330-S335(2021).https://doi.org/10.4103/0028-3886.332275\u003c/li\u003e\n\u003cli\u003eWaqar, U., \u003cem\u003eet al\u003c/em\u003e . Risk factors for intensive care unit admission and mortality among adult meningitis patients. \u003cem\u003eJ Pak Med Assoc.\u003c/em\u003e\u003cstrong\u003e72,\u003c/strong\u003e 1460-1466(2022). https://doi.org/10.47391/JPMA.4482\u003c/li\u003e\n\u003cli\u003eWu, J., Song, X., Hu, Y., Chen, J., \u0026amp; Jiang, L. High-risk factors associated with refractory childhood bacterial meningitis in Southwest China. \u003cem\u003eBMC Pediatr. \u003c/em\u003e\u003cstrong\u003e23,\u003c/strong\u003e 220 (2023).https://doi.org/10.1186/s12887-023-04007-z\u003c/li\u003e\n\u003cli\u003eWang, H., \u0026amp; Zhu, X.Cerebrospinal fluid culture-positive bacterial meningitis increases the risk for neurologic damage among neonates. \u003cem\u003eAnn Med. \u003c/em\u003e\u003cstrong\u003e53, \u003c/strong\u003e2199-2204 (2021). https://doi.org/10.1080/07853890.2021.2004318\u003c/li\u003e\n\u003cli\u003eTing, J. Y., \u003cem\u003eet al \u003c/em\u003e. Predictive value of repeated cerebrospinal fluid parameters in the outcomes of bacterial meningitis in infants \u0026lt;90 days of age. \u003cem\u003ePlos One. \u003c/em\u003e\u003cstrong\u003e15, \u003c/strong\u003ee0238056 (2020). https://doi.org/10.1371/journal.pone.0238056\u003c/li\u003e\n\u003cli\u003eAgarwal, R., \u0026amp; Emmerson, A. J. Should repeat lumbar punctures be routinely done in neonates with bacterial meningitis?. Results of a survey into clinical practice. \u003cem\u003eArch Dis Child.\u003c/em\u003e\u003cstrong\u003e84,\u003c/strong\u003e 451-2 (2001).https://doi.org/10.1136/adc.84.5.450d\u003c/li\u003e\n\u003cli\u003eGreenberg, R. G., et al. Repeat lumbar punctures in infants with meningitis in the neonatal intensive care unit. \u003cem\u003eJ Perinatol.\u003c/em\u003e\u003cstrong\u003e31,\u003c/strong\u003e 425-9 (2011). https://doi.org/10.1038/jp.2010.142\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTable 1. Baseline characteristics in neonates with and without hydrocephalus in bacterial meningitis(n =227).\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"587\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003eCharacteristics\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003eWithout\u0026nbsp;\u003c/p\u003e\n \u003cp\u003ehydrocephalus(n=154)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003eWith\u003c/p\u003e\n \u003cp\u003ehydrocephalus(n=73)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e- value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003eGA at birth , mean(SD), weeks\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003e38.4(2.2）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003e37.8(2.4）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003e0.03\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003eFemale, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003e50(32.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003e25(34.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003e0.79\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003eVaginal delivery, n (%)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003e107(69.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003e50(68.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003e0.88\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003eBirth weight, mean(SD), grams,\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003e2997.2(575.2）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003e3014.0(575.6）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003e0.42\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003eDay of onset, mean(SD), days\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003e15.7(11.0）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003e18.9(15.1）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003e0.11\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003eFever,n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003e148(96.1）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003e65(89.0）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003e0.04\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003eConvulsion at onset,\u0026nbsp;n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003e24(15.6）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003e23(31.5）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003e0.006\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003eAltered consciousness,\u0026nbsp;n (%)\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003e16(10.4）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003e24(32.9）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003ePositive bacterial culture,\u0026nbsp;n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003e100(64.9）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003e63(86.3）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003eCRP \u0026gt;100mg/L,\u0026nbsp;n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003e56(36.36）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003e52(71.2）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003eSubdural effusion, n(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003e31(20.1)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003e21(28.8)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003e0.15\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003eEncephalopyosis, n(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003e1(0.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003e15(20.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003eEpendymitis, n(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003e2(1.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003e19(26.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 147px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eAbbreviations: CRP, C-reactive protein; GA，gestational age;\u0026nbsp;n, number;\u0026nbsp;SD,\u0026nbsp;standard deviations.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2.\u0026nbsp;\u003c/strong\u003eThe etiology of CSF culture in the 227 neonates.\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eBacterias\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003eWith\u003c/p\u003e\n \u003cp\u003ehydrocephalus(n=73)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003eWithout\u0026nbsp;\u003c/p\u003e\n \u003cp\u003ehydrocephalus(n=154)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003e63\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e100\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e\u003cem\u003eEscherichia coli\u003c/em\u003e, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003e23(36.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e33(33%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e\u003cem\u003eGroup B streptococcus\u003c/em\u003e, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003e19(30.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e43(43%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e\u003cem\u003eStreptococcus pneumoniae\u003c/em\u003e,\u0026nbsp;n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003e6(9.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e5(5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e\u003cem\u003eKlebsiella aerogenes,\u003c/em\u003e n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003e2(3.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e2(2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e\u003cem\u003eLizabethkingia meningosepticum\u003c/em\u003e, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003e4(6.3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e1(1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e\u003cem\u003eSerratia marcescens\u003c/em\u003e\u003cem\u003e,\u003c/em\u003e n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003e2(3.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e\u003cem\u003eStreptococcus gallolyticus\u003c/em\u003e\u003cem\u003e,\u0026nbsp;\u003c/em\u003en (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003e1(1.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e3(3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e\u003cem\u003eStaphylococcus aureus\u003c/em\u003e\u003cem\u003e,\u0026nbsp;\u003c/em\u003en (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003e1(1.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e4(4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e\u003cem\u003eAcinetobacter baumannii\u003c/em\u003e,\u0026nbsp;n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e2(2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003e\u003cem\u003eEnterococcus faecium\u003c/em\u003e\u003cem\u003e,\u003c/em\u003e n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e3(3%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 180px;\"\u003e\n \u003cp\u003eOthers,\u0026nbsp;n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 127px;\"\u003e\n \u003cp\u003e5(7.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 133px;\"\u003e\n \u003cp\u003e4(4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 3. The CSF characteristics of bacteria meningitis with and without hydrocephalus (n =227).\u0026nbsp;\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 163px;\"\u003e\n \u003cp\u003eCharacteristics\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003eWithout \u0026nbsp;hydrocephalus\u003c/p\u003e\n \u003cp\u003e(n=154)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003eWith\u003c/p\u003e\n \u003cp\u003ehydrocephalus(n=73)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e\u003cem\u003eP-\u003c/em\u003e value\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 163px;\"\u003e\n \u003cp\u003eFirst lumbar puncture\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 163px;\"\u003e\n \u003cp\u003eWhole CSF WBC\u0026nbsp;median(range),10^6/L\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003e613(17-53710）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e2451(82-38426）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 163px;\"\u003e\n \u003cp\u003eGlucose mean(SD), \u0026nbsp;mmol/L\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003e1.73(1.02）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e0.89(1.08）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 163px;\"\u003e\n \u003cp\u003eChloride,\u0026nbsp;mean (SD),\u0026nbsp;mmol/L\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003e119.67(5.84）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e117.38(23.32）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e0.27\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 163px;\"\u003e\n \u003cp\u003eProtein,\u0026nbsp;mean(SD),\u0026nbsp;g/L\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003e2.21(1.59）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e4.37(4.48）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 163px;\"\u003e\n \u003cp\u003eSecond lumbar puncture\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 163px;\"\u003e\n \u003cp\u003eWhole CSF WBC\u0026nbsp;median(range),10^6/L\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003e118(2-44710）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e736.5(12-68637）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 163px;\"\u003e\n \u003cp\u003eGlucose,\u0026nbsp;mean(SD),\u0026nbsp;mmol/L\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003e1.85(0.64）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e1.17(1.13）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 163px;\"\u003e\n \u003cp\u003eChloride,\u0026nbsp;mean(SD),\u0026nbsp;mmol/L\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003e122.28(4.14）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e117.86(7.22）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 163px;\"\u003e\n \u003cp\u003eProtein,\u0026nbsp;mean(SD),\u0026nbsp;g/L\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003e1.65(0.99）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e4.14(2.89）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 163px;\"\u003e\n \u003cp\u003eThird lumbar puncture\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 163px;\"\u003e\n \u003cp\u003eWhole CSF WBC,\u0026nbsp;median (range),\u0026nbsp;10^6/L\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003e27.5(1-628）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e120(1.75-13433）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 163px;\"\u003e\n \u003cp\u003eGlucose,\u0026nbsp;mean(SD),\u0026nbsp;mmol/L\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003e2.18(0.92）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e1.58(0.93）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 163px;\"\u003e\n \u003cp\u003eChloride,\u0026nbsp;mean(SD),\u0026nbsp;mmol/L\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003e122.77(3.45）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e120.86(7.57）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e0.03\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 163px;\"\u003e\n \u003cp\u003eProtein,\u0026nbsp;mean(SD),\u0026nbsp;g/L\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 173px;\"\u003e\n \u003cp\u003e1.67(2.89）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 121px;\"\u003e\n \u003cp\u003e4.21(5.10）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 110px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eAbbreviations: CSF: cerebrospinal fluid; n, number; SD, standard deviations; WBC: white blood cell count.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4.\u0026nbsp;\u003c/strong\u003eUnivariate and multivariate analysis of risk factors for\u0026nbsp;hydrocephalus in bacterial meningitis.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"619\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003ePotentially relevant factor\u003c/p\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 243px;\"\u003e\n \u003cp\u003eUnivariate analysis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"2\" valign=\"top\" style=\"width: 243px;\"\u003e\n \u003cp\u003eMultivariate analysis\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e- value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eOR (95% CI)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e- value\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003eOR (95% CI)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eFemale\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e0.79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e0.92[0.51-1.66]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e0.712\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e0.83[0.31-2.25]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eGA at birth \u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e0.07\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e0.90[0.73-1.01]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e0.247\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e0.88[0.70-1.10]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eConvulsion at onset\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e0.003\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e2.65[1.38-5.10]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e0.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e3.47[1.13-10.66]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eCRP \u0026gt;100mg/L\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e4.33[2.37-7.93]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e0.008\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e3.72[1.41-9.78]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003ePositive bacterial culture\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e3.31[1.57-6.97]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e0.453\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e1.60[0.47-5.51]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eFirst CSF WBC \u0026gt; 5000*10^6/L\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e3.50[1.80-6.81]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e0.028\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e3.34[1.14-9.80]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eInitial CSF glucose \u0026lt;1.1 mmol/L\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e6.60[3.56-12.26]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e0.98\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e0.99[0.35-2.80]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eFirst CSF protein \u0026gt;4g/L\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e6.60[2.47-10.35]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e0.383\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e0.59[0.18-1.95]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eSecond CSF WBC \u0026gt; 500*10^6/L\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e9.14[5.02-18.53]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e0.006\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e4.55[1.55-13.34]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eSecond \u0026nbsp;CSF glucose \u0026lt;1.1 mmol/L\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e13.55[6.60-27.81]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e6.35[2.17-18.55]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eSecond CSF protein \u0026gt;4g/L\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e18.54[6.77-50.82]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e12.34[2.72-56.05]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eThird CSF WBC \u0026gt; 100*10^6/L\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e5.72[3.08-10.61]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e0.016\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e3.33[1.25-8.86]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eThird CSF protein \u0026gt; 4g/L\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e9.96[3.81-26.04]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e0.19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e0.29[0.04-1.86]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 132px;\"\u003e\n \u003cp\u003eencephalopyosis\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e53.83[7.04-411.81]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 101px;\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 142px;\"\u003e\n \u003cp\u003e48.47[4.51-520.46]\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eAbbreviations: CRP, C-reactive protein; CSF: cerebrospinal fluid; GA, gestational age; n, number; WBC: white blood cell count.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 5. Predictive value of second CSF parameters for hydrocephalus in bacterial meningitis.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\" width=\"576\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eParameter\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eAUC\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e95% CI\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003eCut-off\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003eSensitivity\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003eSpecificity\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003eYouden index\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e2nd CSF WBC(10^6/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e0.820\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e[0.761-0.879]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e204.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e0.824\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e0.691\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.515\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e2nd CSF Glucose\u003c/p\u003e\n \u003cp\u003e(mmol/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e0.753\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e[0.673-0.833]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e1.24\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e0.618\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e0.845\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.463\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 81px;\"\u003e\n \u003cp\u003e2nd CSF protein\u003c/p\u003e\n \u003cp\u003e(mmol/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 72px;\"\u003e\n \u003cp\u003e0.818\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e[0.758-0.879]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e1.53\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 90px;\"\u003e\n \u003cp\u003e0.912\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 91px;\"\u003e\n \u003cp\u003e0.583\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 76px;\"\u003e\n \u003cp\u003e0.495\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eAbbreviations: AUC: area under the curve ; CI: confidence Interval;\u0026nbsp;CSF: cerebrospinal fluid;\u003c/p\u003e\n\u003cp\u003e\u003csup\u003ea\u0026nbsp;\u003c/sup\u003eYouden index= sensitivity+specificity-1\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 6.\u0026nbsp;\u003c/strong\u003eNeurological outcomes\u0026nbsp;of patients with hydrocephalus versus without hydrocephalus.\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 149px;\"\u003e\n \u003cp\u003eCharacteristics\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003eWithout\u0026nbsp;\u003c/p\u003e\n \u003cp\u003ehydrocephalus(n=154)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003eWith\u003c/p\u003e\n \u003cp\u003ehydrocephalus(n=73)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003e\u003cstrong\u003e\u003cem\u003ep\u003c/em\u003e\u003c/strong\u003e\u003cstrong\u003e- value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 149px;\"\u003eOmmaya reservoir, n (%)\u003cbr\u003e\u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e36(49.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 149px;\"\u003e\n \u003cp\u003ePermanent shunt, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e25(34.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003eNA\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 149px;\"\u003e\n \u003cp\u003eFollow-up\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 149px;\"\u003e\n \u003cp\u003eSecondary epilepsy, n(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e6(3.9)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e27((37.0)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 149px;\"\u003e\n \u003cp\u003eHearing impairment, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e24(15.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e39(53.4)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 149px;\"\u003e\n \u003cp\u003eEncephalomalacia, n(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e7(4.5)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e29(39.7)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" style=\"width: 149px;\"\u003e\n \u003cp\u003eDeath, n (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e1(0.6)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 141px;\"\u003e\n \u003cp\u003e6(8.2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" style=\"width: 137px;\"\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Bacterial meningitise, Hydrocephalus, Cerebrospinal fluid, Predictive factors, Prognosis","lastPublishedDoi":"10.21203/rs.3.rs-7841321/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7841321/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eHydrocephalus is one of the most common complications of bacterial meningitis (BM). A retrospective case-control study were conducted to evaluate the etiologies, predictive factors and adverse outcomes of hydrocephalus in BM. A total of 227 neonates who met the inclusion criteria were enrolled in the study cohort, of which 73 neonates with hydrocephalus. Escherichia coli and Group B streptococcus were the most common causative pathogens causing hydrocephalus. The factors that were significantly associated with hydrocephalus in multivariate analysis were: encephalopyosis, second CSF glucose\u0026thinsp;\u0026lt;\u0026thinsp;1.1 mmol/L, second CSF protein\u0026thinsp;\u0026gt;\u0026thinsp;4 g/L, C-reactive protein (CRP)\u0026thinsp;\u0026gt;\u0026thinsp;100 mg/L, third CSF WBC\u0026thinsp;\u0026gt;\u0026thinsp;100\u0026times;10^6/L, convulsion at onset, and initial CSF WBC\u0026thinsp;\u0026gt;\u0026thinsp;5000\u0026times;10^6/L. The receiver operating characteristic results also showed CSF WBC, CSF glucose, and protein level on the second LP also had predictive value for hydrocephalus. Neonates with hydrocephalus in BM had significantly higher ratio of secondary epilepsy, hearing impairment, encephalomalacia, and death in the two year of life (all \u003cem\u003eP\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05). Together these data demonstrated that a severe clinical manifestation and significant CSF parameters at admission are the most important predictors of hydrocephalus in neonatal BM. Hydrocephalus in BM was significantly associated with mortality and poor outcome.\u003c/p\u003e","manuscriptTitle":"Clinical Features, Outcomes, Predictive Factors and Prognosis of Hydrocephalus in Neonatal Bacterial Meningitis: A Prospective Case-Control Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-11-19 09:57:07","doi":"10.21203/rs.3.rs-7841321/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-12-01T10:55:06+00:00","index":"","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-11-30T15:33:39+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-11-29T11:10:20+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"228129799011076490678291480765170096003","date":"2025-11-12T10:35:11+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"174218022258834014217990954140166170873","date":"2025-11-09T07:04:44+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-11-07T06:28:59+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2025-10-24T17:08:48+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-10-13T07:26:08+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-10-13T07:25:00+00:00","index":"","fulltext":""},{"type":"submitted","content":"Scientific Reports","date":"2025-10-12T14:24:31+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"scientific-reports","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"scirep","sideBox":"Learn more about [Scientific Reports](http://www.nature.com/srep/)","snPcode":"","submissionUrl":"","title":"Scientific Reports","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Scientific Reports","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"399f8de1-f2c2-48f0-ade3-b1d8bc5a209b","owner":[],"postedDate":"November 19th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[{"id":58086584,"name":"Health sciences/Diseases"},{"id":58086585,"name":"Health sciences/Medical research"},{"id":58086586,"name":"Biological sciences/Microbiology"},{"id":58086587,"name":"Health sciences/Neurology"},{"id":58086588,"name":"Biological sciences/Neuroscience"}],"tags":[],"updatedAt":"2026-05-04T16:01:09+00:00","versionOfRecord":{"articleIdentity":"rs-7841321","link":"https://doi.org/10.1038/s41598-026-50052-w","journal":{"identity":"scientific-reports","isVorOnly":false,"title":"Scientific Reports"},"publishedOn":"2026-05-01 15:58:12","publishedOnDateReadable":"May 1st, 2026"},"versionCreatedAt":"2025-11-19 09:57:07","video":"","vorDoi":"10.1038/s41598-026-50052-w","vorDoiUrl":"https://doi.org/10.1038/s41598-026-50052-w","workflowStages":[]},"version":"v1","identity":"rs-7841321","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7841321","identity":"rs-7841321","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}