Meningitis Trends and Association With Intraventricular Hemorrhage in Very Preterm Infants

Abstract

Background: Meningitis is often considered to be a subset of neonatal infections that should respond to infection control strategies; however, a preliminary report from the Canadian Neonatal Network (CNN) indicated that an infection control program decreased late onset sepsis but not meningitis. There was also no significant decrease in the incidence of severe neurological injury. We aimed to compare trends in the incidence of late onset sepsis and meningitis among very preterm infants in Canada, and to determine whether there is an association between late onset meningitis and intraventricular hemorrhage (IVH). Methods: All very preterm infants <33 weeks gestational age admitted to tertiary level neonatal intensive care units (NICUs) in the CNN from 2010-2018 were included. Statistical analyses were performed to compare the trends for incidence rates of late onset culture positive bloodstream infection (CPBSI) and late onset meningitis, and to examine the association of meningitis and IVH (exposure), after adjustment for patient risks. Findings: Of 36,573 infants in this study, 32,198 had no infections, 3977 had only late onset CPBSI and 398 had late onset meningitis. Between 2010 and 2018, there was a significant decrease in the incidence of late onset CPBSI (rates decreased from 14% to 11%; (AOR)=0.93; 95%CI 0.92, 0.95) but not for late onset meningitis (rates were not significantly changed from 1.5% to 1.2%; (AOR)=0.98; 95%CI 0.94, 1.01). Infants with IVH grade 3 or above had higher odds of late onset meningitis compared with infants with no infection (AOR 4.16; 95%CI 3.17, 5.44), and infants with late onset CPBSI (AOR 4.11; 95%CI 3.08, 5.50). Interpretation: There was a decreasing trend of late onset CPBSI but not meningitis. An association between late onset meningitis and IVH was observed. Late onset CPBSI and meningitis may have different risk factors and require different prevention strategies. Funding Statement: Canadian Institutes of Health Research (CTP 87518), (APR-126340 to PSS). Declaration of Interests: The authors have no actual or potential financial or personal conflicts of interest to disclose. Ethics Approval Statement: Data collection at each site was approved by either a research ethics board or quality improvement committee. The current study was approved by the Executive Committee of the CNN and by the Mount Sinai Hospital Research Ethics Board in Toronto, Ontario.