Abstract
Background: Neonatal bacterial meningitis is a severe infection with high mortality and morbidity. It is necessary to identify factors associated with a high risk of a poor prognosis so that we can prevent them with more appropriate treatments. This study was performed to summarize the prognostic factors known to predict adverse outcomes in neonatal bacterial meningitis.Methods: The Medline/PubMed, Cochrane Library and Embase databases were searched for studies of prognostic risk factors in neonates with bacterial meningitis. Studies published from the initiation of the database to April 30th, 2017 were included. The quality of cohort studies was assessed by the Newcastle-Ottawa Scale (NOS). The quality of cross-section studies was assessed by the Agency for Healthcare Research and Quality (AHRQ) scale. Each prognostic factor known to cause adverse outcomes is summarized.Results: Sixteen studies were identified, including 7 cohort studies and 9 cross section studies. Seizure and high protein levels in the cerebrospinal fluid (CSF) predict a poor prognosis in this disease. Coma, the need for ventilation support, and leukopenia also had some value for predicting poor prognoses. A bulging anterior fontanelle was valuable for predicting mortality. Low CSF glucose levels, thrombocytopenia, gestational age (GA) < 37 weeks and an altered sensorium were correlated with a poor prognosis. A birth weight < 2500 g, early onset meningitis and positive CSF cultures were correlated with mortality.Conclusions: This study provides a preliminary exploration of prognostic factors in neonatal bacterial meningitis and thereby fills some of the gaps in the study of prognoses in this disease. These prognostic factors can be used to predict and estimate outcomes in neonatal bacterial meningitis. Without a meta-analysis, the reliability of these factors cannot be assured. In addition, these results emphasize that there is an urgent need for a standardized protocol for follow-up and well-designed prognostic studies in neonatal bacterial meningitis.
Highlights
Neonatal bacterial meningitis (NBM) is a serious acute infection of the central nervous system
The Medline/PubMed, Cochrane Library and Embase databases were systematically searched for prognostic studies that described risk factors for mortality and sequelae in neonates with bacterial meningitis
The key words used as search terms were “neonate,” “bacterial meningitis,” and “prognostic factors or outcomes.”
Summary
Neonatal bacterial meningitis (NBM) is a serious acute infection of the central nervous system. The guidelines of the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) published in 2016 [7] revealed some of the principles of and latest developments in efforts aimed at dealing with bacterial meningitis, it did not provide any factors that significantly affect mortality or sequelae in affected neonatal patients. There is lack of systematic reviews of prognostic factors that can be used to predict poor prognoses in neonatal bacterial meningitis. This study was performed to collect the currently available evidence to systematically review the prognostic factors that predict or relate to adverse outcomes in neonate bacterial meningitis. Neonatal bacterial meningitis is a severe infection with high mortality and morbidity. This study was performed to summarize the prognostic factors known to predict adverse outcomes in neonatal bacterial meningitis
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