Meningitis in Preterm Neonates: Importance of Cerebrospinal Fluid Parameters

Smith, Patrick B.; Garges, Harmony P.; Cotton, C. Michael; Walsh, Thomas J.; Clark, Reese H.; Benjamin, Daniel K.

doi:10.1055/s-0028-1083839

Cited by 74 publications

(68 citation statements)

References 15 publications

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“…Mean glucose level and protein levels were 57 ± 27 (6-271) mg/dl and 92 ± 72 (10-641) mg/dl, respectively. Smith et al [41] reported similar CSF findings except that they detected higher protein levels.…”

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confidence: 63%

Neonatal bacterial meningitis in Turkey: epidemiology, risk factors, and prognosis

Kavuncuoğlu

Gürsoy

Türel

et al. 2013

J Infect Dev Ctries

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Introduction: We aimed to determine the incidence, etiology, risk factors and outcome of bacterial meningitis in neonates. Methodology: Neonates who developed bacterial meningitis between 2003 and 2010 in a tertiary hospital in Turkey were included in the study. Patients born in our hospital were defined as Group 1 and patients referred from other centres were defined as Group 2. Patients with evidence of congenital infections or central nervous system malformations were excluded. Demographic features, delivery type, time of onset of meningitis, co-morbidities, clinical features, blood and cerebrospinal fluid (CSF) analysis, cranial sonographic findings, and outcome of patients were recorded. Results: The study comprised 325 meningitis cases identified from 38,023 hospitalised patients in the neonatology unit among 11,8091 live births. Mean gestational age, birth weight, and hospital stay were 36.8±3.7 weeks, 2.480±924 g, and 26±12.4 days, respectively. Almost half (48%) of the patients were diagnosed in the first seven postnatal days and 52% at 8-30 days after birth. CSF culture findings were positive in 59 (18%) patients (28 in Group 1 and 31 in Group 2). Gram-positive bacteria were the responsible agents in 30 (51%) patients, whereas 26 (44%) patients had Gram-negative bacterial meningitis and 3 (5%) had Candida meningitis. Gram-negative bacteria were predominant in Group 1 whereas Gram positive bacteria were predominant in Group 2. Transfontanel ultrasonography revealed pathologic findings in 17.5% of patients. The total mortality rate was 2.5%. Conclusion: This large-scale study provides essential information about the etiology, characteristics, and outcome of neonatal bacterial meningitis in Turkey.

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confidence: 63%

Neonatal bacterial meningitis in Turkey: epidemiology, risk factors, and prognosis

Kavuncuoğlu

Gürsoy

Türel

et al. 2013

J Infect Dev Ctries

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“…56 The CSF glucose concentration in the term infant is usually between 70% and 80% of a simultaneously measured serum glucose; a low CSF glucose has the greatest specificity for bacterial meningitis. 37,57 Bacterial meningitis may occur in infants with normal CSF parameters who concomitantly have a high concentration of bacterial organism. This observation accentuates the need to utilize culture-based and non-culture-based assessments in combination with clinical evaluation for optimal diagnosis and management.…”

Section: Csf Cell Count and Chemistriesmentioning

confidence: 99%

Recent Developments and Current Issues in the Epidemiology, Diagnosis, and Management of Bacterial and Fungal Neonatal Sepsis

2013

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The definition of neonatal sepsis is complicated by the frequent presence of noninfectious conditions that resemble those of sepsis, especially in very low-birth-weight (VLBW) preterm infants and by the absence of optimal diagnostic tests. Although growth of an organism from a sterile site is the "gold standard" for definitive diagnosis, it is not always possible to isolate a causative pathogen. Invasive infections can occur in seemingly asymptomatic neonates. Therefore, assessment of history and risk factors in combination with diagnostic tests are used to identify neonates who are more likely to be infected.The definitions of early onset sepsis (EOS) and late onset sepsis (LOS) are subject to subspecialist variation. Many investigators, including those who participate in the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Neonatal Network and the Vermont Oxford Network, define EOS by the onset of signs/symptoms and an associated positive culture at or before 72 hours of life. LOS is characterized by the onset of symptoms consistent with sepsis at greater than 72 hours of life. These classifications of EOS and LOS reflect the differing etiologies and proposed pathophysiology of pathogens commonly associated with the timing of Keywords ► neonatal sepsis ► invasive candidiasis ► epidemiology ► management AbstractIdentifying neonates with sepsis is complicated by variability in clinical presentation. The incidence of early onset sepsis (EOS) resulting from invasive group B streptococcal (GBS) infections has been notably reduced by the widespread delivery of intrapartum antibiotic prophylaxis. Rates of EOS attributable to non-GBS etiologies have remained constant, and ampicillin-resistant Escherichia coli has become more prevalent. Lateonset sepsis (LOS) attributable to gram-positive organisms including coagulase-negative Staphylococci and Staphylococcus aureus is associated with increased morbidity and mortality among premature infants. Invasive candidiasis is an emerging cause of LOS, especially among infants who receive broad-spectrum antimicrobial agents. Prophylactic fluconazole administration to very low-birth-weight (VLBW) neonates during the first 6 weeks of life prevents invasive candidiasis in neonatal intensive care units (NICU) with high rates of fungal infections. Targeted fluconazole prophylaxis may be beneficial in VLBW neonates who receive care in NICUs with lower rates of invasive fungal infections. Assessment of immune function, neutrophil markers, acute phase reactants, and utilization of sepsis screening scores may contribute to the management of sepsis. Maternal decolonization, antimicrobial stewardship, early enteral feeding, and optimal infection control practices are potential practical strategies for reducing the burden of neonatal sepsis.

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“…The larger number of patients included in that multicenter study must be emphasized, as it could explain the differences found. Garges et al 11 evaluated the correlation between CSF culture, blood culture and CSF parameters and observed that, for the meningitis cases confirmed by culture, a leukocyte count greater than 0/mm Neonatal meningitis in a tertiary center Bentlin et al 25 . In agreement with data in the literature, complications such as ventriculitis, hydrocephaly and abscesses were more frequent in Gram-negative meningitis.…”

Section: Discussionmentioning

confidence: 99%

Neonatal meningitis according to the microbiological diagnosis: a decade of experience in a tertiary center

Bentlin¹,

Ferreira²,

Rugolo³

et al. 2010

Arq. Neuro-Psiquiatr.

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The aim of this study was to evaluate the incidence of and mortality due to meningitis and compare data according to microbiological diagnosis. This was a ten-year retrospective study conducted at a neonatal intensive care unit (NICU). Newborns with meningitis confirmed by positive CSF culture were included; those with congenital infection or malformations that made lumbar puncture impossible were excluded. The variables investigated were birth weight, gestational and postnatal age, procedures, hematological and CSF parameters, and complications. Parametric and non-parametric tests were used (statistical value p<0.05). The incidence of meningitis was 0.6% and mortality was 27%. Of the 22 cases, 59% involved Gram-negative bacteria; 36% Gram-positive and 5% fungi. The groups did not differ in relation to birth weight, gestational and postnatal age, procedures or hematological and CSF parameters. Sepsis, convulsions and deaths were frequent in both groups, without statistical difference. Gram-negative cases showed abscesses and higher frequency of ventriculitis and hydrocephaly. Meningitis was infrequent, but presented high mortality and frequent complications. Key words: meningitis, newborn, central nervous system, sepsis.Meningite neonatal de acordo com diagnóstico microbiológico: uma década de experiência em centro terciário RESUMO O objetivo do estudo foi avaliar incidência e mortalidade da meningite e comparar dados de acordo com o diagnóstico microbiológico. Estudo retrospectivo, de 10 anos, em UTI Neonatal. Incluídos RNs com meningite confirmada por cultura de líquor positiva; RN com infecção congênita ou malformações que impedem punção lombar foram excluídos. Variáveis: peso ao nascimento, idades gestacional e pós natal, procedimentos, parâmetros hematológicos e liquóricos, complicações. Testes paramétricos e não paramétricos foram utilizados (valor estatístico p<0,05). A incidência de meningite foi de 0,6% e mortalidade de 27%. Dos 22 casos, 59% foram por bactérias Gram-negativas; 36% por bactérias Grampositivas e 5% por fungos. Grupos não diferiram quanto ao peso ao nascimento, idades gestacional e pós-natal, procedimentos e por parâmetros hematológicos e liquóricos. Sepse, convulsões e óbitos foram frequentes e não diferiram entre os grupos. Gramnegativos causaram abscessos e mais frequentemente ventriculite e hidrocefalia. Meningite não foi freqüente, mas apresentou alta mortalidade e complicações. Palavras-chave: meningite, recém-nascido, sistema nervoso central, sepse.

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Meningitis in Preterm Neonates: Importance of Cerebrospinal Fluid Parameters

Cited by 74 publications

References 15 publications

Neonatal bacterial meningitis in Turkey: epidemiology, risk factors, and prognosis

Neonatal bacterial meningitis in Turkey: epidemiology, risk factors, and prognosis

Recent Developments and Current Issues in the Epidemiology, Diagnosis, and Management of Bacterial and Fungal Neonatal Sepsis

Neonatal meningitis according to the microbiological diagnosis: a decade of experience in a tertiary center

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