Abstract
OBJECTIVE: Despite improvements in neonatal care, neonatal bacterial meningitis is still an emerging problem worldwide with high rates of mortality. The present study evaluates data on suspected- and culture-proven neonatal bacterial meningitis in the light of a single tertiary reference center experience in Turkey in comparison with the globe. STUDY DESIGN: In this retrospective cohort study newborns admitted to Hacettepe University Ihsan Dogramaci Children’s Hospital Neonatal Intensive Care Unit during a 5-year-period between April 2014-May 2019 and who underwent atraumatic lumbar puncture were included. RESULTS: Two hundred sixty-four patients fulfilled the inclusion criteria. Most common symptoms in all patients raised suspicion in favor of NBM and resulted in lumbar puncture were fever (34.5%, n=91), respiratory distress (31.1%, n=82), lethargy (31.1%, n=82), and apnea (26.1%, n=69). The incidence of culture-proven NBM among suspected patients was 5.7% (n=15/264); while the incidence is 3.1 per 1000 (15/4574) at all Neonatal Intensive Care Unit admissions. Respiratory distress (60.0%, n=9/15) and apnea (40.0%, n=6/15) were the most common symptoms in patients with NBM; which may be due to the predominance of premature newborns in the NBM group. The most common microorganisms in CSF cultures were coagulase-negative Staphylococci with Methicillin-resistant Staphylococcus epidermidis being most common among all. CONCLUSIONS: The present study underlines high rates of culture-proven neonatal bacterial meningitis among suspected newborns despite improvements in modern health care, which raises attention to careful evaluation of these patients and early administration of properly-selected antibiotics. Our incidence rates are in keeping with studies from the developed world.
Highlights
This retrospective cohort study included all newborns who were admitted to Hacettepe University Ihsan Dogramaci Children’s Hospital Neonatal Intensive Care Unit (NICU) during a 5-year-period between April 2014-May 2019, who underwent atraumatic lumbar puncture (LP) and successful withdrawal of cerebrospinal fluid (CSF) proceeding a suspicion of meningitis
4.574 newborns were admitted to NICU for different causes; 646 of them underwent an LP proceeding with suspicion of meningitis at admission or during the stay
264 of them fulfilled the inclusion criteria owing to an atraumatic LP with the successful withdrawal of CSF
Summary
(Articles in Press) the neonatal period due to its higher incidence and mortality compared to any other age [1,2,3,4,5,6,7,8]. The incidence and mortality rates of culture-proven neonatal bacterial meningitis (NBM) in developed vs developing countries range between 0.2-0.3 vs 0.8-6.1 per 1000 live births and 10-15% vs 11-58%, respectively [5,6,7,8,9,10,11,12,13,14,15]. Despite a declining trend in incidence and rates of mortality due to improvements in neonatal care, morbidity is still a great concern among surviving neonates which are subject to many short- (ventriculitis, cerebritis, and brain abscess) and long-term complications (loss of hearing and vision, focal neurological deficits, convulsions, delays in neurocognitive development) [1,2,3,10,12,13]
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