Clinical Outcomes of Neonatal Meningitis in Very-Low-Birth-Weight Infants

Abstract

We sought to describe the clinical presentation and consequences of meningitis among 64 very-low-birth-weight (VLBW <1.5 kg) infants who had 67 culture-proven episodes of meningitis over an 18-year period, 1977 through 1995. Demographic and neonatal descriptors of meningitis and later outcomes were retrospectively examined and neurodevelopmental outcomes of 39 of 45 (87%) meningitis survivors were compared to those of nonmeningitis survivors followed up to 20 months corrected age. Causes of meningitis included coagulase-negative Staphylococcus in 43% of episodes, other gram-positive bacteria in 19%, gram-negative bacteria in 17%, and Candida species in 20% of episodes. Spinal fluid abnormalities were sparse, regardless of etiologic organism. Of 38 nonbloody spinal fluid taps (<1,000 erythrocytes/mm3), 6 had >30 leukocytes/mm3, 5 protein >150 mg/dL%, and 6 glucose <30 mg/dL (1.67 mmol/L). Only 10 infants (26%) had 1 or more of these spinal fluid abnormalities. Meningitis survivors had a higher rate of major neurologic abnormality (41% vs 11%, p<0.001) and subnormal (<70) Mental Development Index (38% vs 14%, p<0.001) than nonmeningitis survivors. Impairment rates did not differ by etiologic organism. The effect of meningitis on neurologic outcome persisted even after controlling for birth weight, intraventricular hemorrhage, chronic lung disease, and social risk factors (odds ratio 2.27 [95% CI 1.02, 5.05]). We conclude that despite a sparsity of abnormal spinal fluid findings, culture-proven neonatal meningitis among VLBW infants has a detrimental effect on neurologic outcome, which persists even after controlling for other risk factors.

Neonatal Candida meningitis: significance of cerebrospinal fluid parameters and blood cultures

“…A similar percentage of infants with elevated CSF WBC count (52%, 9/17) was observed in another cohort of infants with definite Candida meningitis, 9 and an even lower percentage (20%, 2/10) was found in another series. 10 In a recent multi-center study, 5% (14/293) of candidemic infants had Candida meningitis. 1 In our study of infants receiving an LP, 9% (7/77) of candidemic infants had evidence of Candida meningitis.…”

Clinical Microbiology of Bacterial and Fungal Sepsis in Very-Low-Birth-Weight Infants

“…In a 10-year study of neonatal meningitis in the United Kingdom, moderate or severe disability was detected in 12% of those with birth weight of Ͼ2,500 g, 31% of those with birth weight of 1,500 to 2,499 g, and 44% of those with birth weight of Ͻ1,500 g (204). Similarly, another group found that 41% of 39 VLBW survivors of neonatal meningitis suffered major neurologic sequelae, compared with 11% of matched control infants (114).…”

“…Diagnosis of meningitis is problematic in VLBW infants since the CSF white blood cell count is an unreliable indicator of meningitis in these infants and the lumbar puncture is often delayed until after antimicrobials have been administered, when the patient is judged to be more stable (114). There are no data in preterm infants examining trends in CSF pleocytosis after antibiotics have been administered.…”

Clinical outcome of neonatal bacterial meningitis according to birth weight

“…E-mail: verakrebs@uol.com.br Low birth weight newborns present a 3-fold increased risk of acquiring meningitis when compared to those whose birth weight is ≥2500 g 1 . Among very low birth weight neonates (<1500 g) the risk is a 10 to 17-fold higher [2][3][4] . In addition to the immaturity of the immunological system, these neonates frequently present risk factors for infection related to maternal diseases or neonatal conditions 1,3,5 .…”