Prevalence, predictors, and short-term outcomes of neonatal bacterial meningitis in suspected sepsis: A prospective observational study

IF 1.7 Q2 PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH

Clinical Epidemiology and Global Health Pub Date : 2025-08-13 DOI:10.1016/j.cegh.2025.102157

Prerna Priyadarshini, Arpita Bhriguwanshi, Shalini Tripathi, S.N. Singh

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引用次数: 0

Abstract

Background

Neonatal Meningitis is a critical illness associated with substantial morbidity and mortality. Its timely diagnosis remains challenging due to subtle clinical signs and variability in microbiological profiles, particularly in resource-limited settings. Early identification of reliable clinical and laboratory predictors is essential for improving outcomes in neonates suspected of sepsis.

Objective

To determine the prevalence, predictors and short-term outcomes of bacterial meningitis in neonates with suspected sepsis.

Material and methods

This prospective observational study included neonates admitted with clinical signs of sepsis to a tertiary care neonatal unit in Northern India from February 2020 to July 2021. Neonates with gestational age <28 weeks, major congenital anomalies, or severe perinatal asphyxia were excluded. In our study, neonatal meningitis diagnosis strictly required objective criteria: A positive CSF culture, positive Gram stain, or suggestive findings on cranial ultrasound. We did not consider CSF biochemical parameters (e.g., glucose, protein, leucocyte counts) alone due to their limited specificity and high false-positive rates, especially given prior antibiotic treatment in many neonates.

Results

Out of the 500 neonates enrolled, 90 (18 %) were diagnosed with bacterial meningitis. Logistic regression analysis identified meconium-stained amniotic fluid (Adjusted OR:3.66; 95 % CI: 1.69–7.95; p = 0.001), poor feeding (Adjusted OR:2.98; 95 % CI: 1.12–7.93; p = 0.029), abdominal distension (Adjusted OR:66.32; 95 % CI: 7.74–568.15; p < 0.001), fast breathing (Adjusted OR:3.67; 95 % CI: 1.37–9.80; p = 0.010), jaundice (Adjusted OR:4.15; 95 % CI: 1.62–10.61; p = 0.003), seizures (Adjusted OR:2.76; 95 % CI: 1.12–6.82; p = 0.028), bulging fontanel (Adjusted OR:36.87; 95 % CI: 6.49–209.53; p < 0.001) and positive blood culture (Adjusted OR:2.40; 95 % CI: 1.15–5.01; p = 0.020) as predictors of meningitis in neonates. Mortality in neonates with meningitis was 7.7 %, significantly associated with the requirement for vasopressors (Adjusted OR: 15.25; 95 % CI: 4.5218–51.523; p ≤ 0.001) and mechanical ventilation (Adjusted OR: 6.99; 95 % CI: 2.453–19.9437; p < 0.001).

Conclusion

Our findings indicate a high prevalence of neonatal meningitis in the context of neonatal sepsis. Clinical and laboratory predictors identified in this study could help formulate an effective scoring system for early diagnosis of neonatal meningitis, facilitating prompt and targeted management to improve outcomes in at risk neonates.

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疑似败血症的新生儿细菌性脑膜炎的患病率、预测因素和短期结局：一项前瞻性观察研究

背景：新生儿脑膜炎是一种与大量发病率和死亡率相关的危重疾病。由于细微的临床症状和微生物谱的可变性，特别是在资源有限的环境中，其及时诊断仍然具有挑战性。早期确定可靠的临床和实验室预测因素对于改善疑似脓毒症新生儿的预后至关重要。目的探讨疑似脓毒症新生儿细菌性脑膜炎的患病率、预测因素及近期预后。材料和方法本前瞻性观察性研究纳入了2020年2月至2021年7月在印度北部三级护理新生儿病房接受脓毒症临床症状的新生儿。排除胎龄≤28周、重大先天性异常或严重围产期窒息的新生儿。在我们的研究中，新生儿脑膜炎的诊断严格要求客观标准：脑脊液培养阳性，革兰氏染色阳性，或颅内超声提示。我们没有单独考虑脑脊液生化参数（如葡萄糖、蛋白质、白细胞计数），因为它们的特异性有限，假阳性率高，特别是在许多新生儿之前接受过抗生素治疗的情况下。结果在纳入的500名新生儿中，90名（18%）被诊断为细菌性脑膜炎。Logistic回归分析发现羊水中有粪染色(校正OR:3.66；95% ci: 1.69-7.95；p = 0.001)，喂养不良(调整OR:2.98；95% ci: 1.12-7.93；p = 0.029)、腹胀(调整OR:66.32；95% ci: 7.74-568.15；p & lt;0.001)，呼吸急促(调整后OR:3.67；95% ci: 1.37-9.80；p = 0.010)，黄疸(调整OR:4.15；95% ci: 1.62-10.61；p = 0.003)，癫痫发作(调整OR:2.76；95% ci: 1.12-6.82；p = 0.028)，囟门鼓胀(调整OR:36.87；95% ci: 6.49-209.53；p & lt;0.001)和阳性血培养(调整OR:2.40；95% ci: 1.15-5.01；P = 0.020)作为新生儿脑膜炎的预测因子。新生儿脑膜炎死亡率为7.7%，与血管加压药物的需要量显著相关(调整OR: 15.25；95% ci: 4.5218-51.523；p≤0.001)和机械通气(调整OR: 6.99；95% ci: 2.453-19.9437；p & lt;0.001)。结论：我们的研究结果表明，在新生儿败血症的背景下，新生儿脑膜炎的患病率很高。本研究确定的临床和实验室预测指标有助于制定有效的评分系统，用于新生儿脑膜炎的早期诊断，促进及时和有针对性的管理，以改善高危新生儿的预后。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical Epidemiology and Global Health PUBLIC, ENVIRONMENTAL & OCCUPATIONAL HEALTH-

CiteScore

4.60

自引率

7.70%

发文量

218

审稿时长

66 days

期刊介绍： Clinical Epidemiology and Global Health (CEGH) is a multidisciplinary journal and it is published four times (March, June, September, December) a year. The mandate of CEGH is to promote articles on clinical epidemiology with focus on developing countries in the context of global health. We also accept articles from other countries. It publishes original research work across all disciplines of medicine and allied sciences, related to clinical epidemiology and global health. The journal publishes Original articles, Review articles, Evidence Summaries, Letters to the Editor. All articles published in CEGH are peer-reviewed and published online for immediate access and citation.