Incidence Of Neonatal Meningitis Research Articles

Importance of Lumbar Puncture in Late Onset Sepsis

Neonatal sepsis is the significant reason of neonatal mortality and morbidity and mostly results in extended hospitalization of infants in the neonatal intensive care unit. The sepsis was confirmed by a positive blood culture and a condition is considered clinical sepsis when the blood culture is negative. It is practically not possible to clinically differentiate sepsis from neonatal meningitis. However, a positive CSF for pathogenic bacteria indicates meningitis. Aim: The purpose of this study was to evaluate the frequency of late-onset sepsis in neonates with meningitis and to determine whether CSF analysis and lumbar puncture is mandatory in all cases of late-onset sepsis. Methods: This study was conducted in the Paediatrics department of CMH Abbottabad, and Sharif Medical City Hospital Lahore, and Pathology department of Women Medical and Dental College, Abbottabad for the duration from January 2022 to June 2022 among neonates with late neonatal sepsis. All neonates underwent clinical examination, history, routine tests (blood culture, C-reactive protein, complete blood count) and analysis and culture of cerebrospinal fluid for clinical evaluation of sepsis. Results: All 80 neonates tested positive for clinical sepsis: hematological sepsis was seen in 59 patients and 21 were CSF culture positive for sepsis; 8 (38.9%) of the 21 have positive CSF culture and 13 cases have negative blood culture. The most common clinical symptom was poor suction 70(87.5%), followed by weak moor 61(76.3%), and lethargy 46(57.5%). The Klebsiella spp was common organism seen in 15 children in the blood culture and the most communal organism in the cerebrospinal fluid culture was Staphylococcus aureus in 6 cases. Conclusions: The incidence of neonatal meningitis is high in new-borns with late-onset sepsis. Meningitis in neonates often transpires in the absence of bacteraemia. Therefore, the CSF examination and lumbar puncture are compulsory in all children with late onset sepsis. Keywords: Lumbar puncture, Meningitis, Neonatal sepsis

A study of clinico-bacteriological profile and to determine incidence of meningitis in late onset sepsis in newborn unit of tertiary care teaching hospital in Northern India

Background: The daily risk of mortality in first 4 weeks of life is almost 30-fold higher than post-neonatal period. Late onset sepsis (LONS) and meningitis still continue to be major causes of mortality and morbidity in newborn period. Our study was done to study clinical profile of enrolled newborns with LONS along with incidence of meningitis in them. The objective of this study was to study clinico-bacteriological profile and to determine associated incidence of meningitis in neonates with late onset sepsis (LONS) in a hospital setting in Northern India.Methods: It was a hospital based prospective observational study conducted over a period of 12 months enrolling 122 newborn with >72 hours of age fulfilling inclusion criterias.Results: Out of total 122 enrolled newborn, 37 (30.3%) neonates had meningitis. 71 (58.20%) were of term gestation with majority 61 (50.0%) in age group of 4-7days of life. Incidence of LONS in low birth weight and very low birth weight were 54% and 13.5%. Most commonly seen symptoms in at admission were lethargy, refusal to feed and fever. Blood culture was positive in 45 (36.88%) in neonates with Acinetobacter baumanii, klebsiella pneumonia and Escherichiae coli being most commonly seen organisms. Cerebrospinalfluid (CSF) culture was positive in 4 (10.81%) newborns. Mean duration of hospital stay was 24.75±13.96 days. Mortality in neonatal meningitis was 3 (3.2%).Conclusions: Our study proved that about one third of newborn admitted with LONS also had coexistent meningitis. Thus CSF analysis is a must and it should not be missed as untreated meningitis can be devastating for newborn. Antibiotics must be added as per antibiogram of specified institute.

Frequency of Meningitis in Neonates with Late Onset Sepsis in Sharif Medical City

Background: Bacterial sepsis and meningitis continue to be major causes of morbidity and mortality in newborns, particularly in premature infants. The present study was undertaken to know the incidence of meningitis in neonates with late onset sepsis. Aim: To determine the frequency of meningitis in neonates with late onset sepsis. Methods: A descriptive cross sectional study was conducted in department of pediatrics at sharif medical city Lahore, from 09-12-2019 to 08-06-2020. One hundred and forty four (144) neonates with late onset sepsis fulfilling the inclusion criteria were included in study. Meningitis was confirmed on lumbar puncture and managed as per hospital protocol. Mean & sd were presented for age, gender, duration of complain and weight. Frequency and percentage were computed for gender and meningitis. Results: Mean age, weight and duration of symptoms in infants with late onset sepsis were 19.50±0.12 days, 3.97±1.17 kg and 4.05±1.98 days. Majority of infants were male i.e. 63.89% (m:f;1:1.7). Mean wbc count of the infants with late onset sepsis was 29.78±9.32.majority of infants had less than 75% neutrophils (68.05%), positive crp (91.67%) and negative blood culture test (52.78%). Frequency of meningitis in neonates with late onset sepsiswas 34.02%. Conclusions: frequency of meningitis in neonates with late onset sepsis was high i.e. 34.02%. Key words: Meningitis; neonates; late onset sepsis

AN OBSERVATIONAL STUDY TO EVALUATE THE INCIDENCE OF MENINGITIS IN NEONATES WITH LATE-ONSET SEPSIS

Introduction: Bacterial sepsis and meningitis continue to be major causes of morbidity and mortality in newborns, particularly in premature infants. The present study was undertaken to know the incidence of meningitis in neonates with late onset sepsis.
 Material and Methods: Hospital based observational study, conducted in department of Pediatrics, Shri krishna Medical College and Hospital Muzaffarpur Bihar India, conducted for a period of one year. 324 patients fulfilling the inclusion criteria were included and subjected to detailed history, clinical examination followed by investigations.
 Results: The annual incidence of meningitis in LOS was 15. The majority of patients (44.44%) presented in the age group of 3-7 days. In meningitis cases 100% cases were lethargic; seizures in 89%, fever in 53%. Blood culture was positive in 33.92% cases of meningitis. Meningitis was seen in 66.66% of proven gram negative sepsis as against 33.34 cases of proven gram positive sepsis and 14.28% expired with meningitis and 4.10% expired with no meningitis. 
 Conclusions: Meningitis is common in late onset sepsis, associated with high mortality.
 Keywords: Meningitis, Preterm, LBW, Lumber puncture

Incidence of meningitis in term neonates with sepsis and antibiotic sensitivity pattern: an observational study

Background: To find out the incidence of meningitis in neonatal sepsis and antibiotic sensitivity pattern in term neonates.Methods: This prospective observational cohort study was done in a tertiary care hospital located in rural South India for a period of 2 years. Blood culture and lumbar puncture were performed for all term babies with clinically suspected sepsis. Growth, if detected was followed by antibiotic sensitivity testing.Results: Of a total of 50 neonates investigated with blood culture, 32(64%) were found to be culture positive for neonatal septicemia, 16 were diagnosed to have meningitis. Meningitis was present in 4(25%) early onset sepsis cases and in 12(75%) late onset sepsis cases (p-value: 0.008). Blood culture showed growth in all of the 16 cases of meningitis, but Cerebro Spinal Fluid (CSF) culture was positive in 5 cases. The most common presenting features are lethargy, seizures, decreased acceptance of feeds, instability of temperature regulation, vomiting, respiratory distress, and apnea. The most common organism in blood culture was Coagulase Negative Staphylococcus (CONS) (20%) followed by Klebsiella spp. (16%). CONS was most sensitive to Linezolid (100%), Vancomycin (90%). Of the 8 cases of Klebsiella, 62.5% cases were sensitive to Colistin and Tigecycline, 50% to Cotrimoxazole. CSF culture was positive in 5(31.25%) cases. CONS and Enterococci spp. were the most common organisms isolated in CSF.Conclusions: Clinical manifestations of meningitis overlap with those of sepsis and are nonspecific. Significant number of neonates with sepsis have meningitis. Hence, it is necessary to rule out meningitis in neonates presented with clinical features of sepsis. CONS was the most common agent isolated in both blood and CSF culture. Routine bacterial surveillance and study of their resistance patterns must be an essential component of neonatal care which helps in implementation of a rational empirical treatment strategy.

Incidence of meningitis in neonates with late-onset sepsis at a Tertiary Care Center in Western India: An observational study

Objective: The objective of this study was to determine the incidence of meningitis in neonates with late-onset sepsis (LOS) in the West India population. Materials and Methods: This prospective observational study enrolled 208 neonates with signs and symptoms suggestive of sepsis with positive C-reactive protein at or more than 72 h of postnatal age. Results: Out of total 208 neonates with LOS, 12.5% neonates had meningitis. The incidence of LOS in preterm and low-birth-weight neonates were 73.6% and 72.1%, respectively. Most common presenting features in neonates with LOS with or without meningitis were respiratory distress (72.6%), followed by lethargy (68.8%) and refusal to feed (63%). Blood culture was positive in 53.8% neonates who had meningitis. Mortality in neonatal meningitis was 3.84%. Conclusion: This study demonstrated that a significant number of neonates with LOS have coexistent neonatal meningitis. Our study highlights the diagnostic utility of routine lumbar puncture in neonates with clinical features of sepsis.

Incidence of meningitis in late onset sepsis

Background: Bacterial sepsis and meningitis continue to be major causes of morbidity and mortality in newborns, particularly in premature infants. The present study was undertaken to know the incidence of meningitis in neonates with late onset sepsis. Methods: Hospital based observational study, conducted in the post graduate department of pediatrics, government medical college, Srinagar, conducted for a period of one year. 423 patients fulfilling the inclusion criteria were included and subjected to detailed history, clinical examination followed by investigations. Results: The annual incidence of meningitis in LOS was 16. The majority of patients (46.1%) presented in the age group of 3-7 days. The mean weight of neonates was 2.61 ± 0.606) kg. 60.3% of neonates with meningitis were of low birth weight (P 0.005). In meningitis cases 100% cases were lethargic; seizures in 92.8%, fever in 50%. Blood culture was positive in 42.6% cases of meningitis. Meningitis was seen in 60.7% of proven gram negative sepsis as against 30.7% cases of proven gram positive sepsis (P <0.005). 94.5% of the exclusively breast fed neonates with meningitis recovered and 6.3% expired whereas for the other feeding group the corresponding figures were 77 % and 22.4 % respectively (P <0.005). 17.6% cases of meningitis had mortality as against 4.8% in those who had sepsis but no meningitis (P <0.005). Conclusions: Meningitis is common in late onset sepsis, associated with high mortality, with a beneficial effect from exclusive breast feeding.

Lumbar Puncture in Neonates with Sepsis

Introduction: Infections are one of the main causes of death during childhood. Epidemiologic studies in Iran showed that the incidence of neonatal sepsis was 1.8% in 1995. Moreover, the incidence of neonatal meningitis is 0.2 to 0.4 in per 1,000 live births. The aim of this study was to determine the necessity of lumbar puncture (LP) in early neonatal sepsis. Methods: In a retrospective study, after obtaining ethical approval, we evaluated the records of 1,100 neonates, younger than 7 days, who were admitted to the hospital between 2001 and 2007. They were suspected of sepsis and thus, LP was performed. Statistical analyses were performed by SPSS version 16. Nominal variables were compared using Chi-square or Fisher’s exact test. Other parametric and non-parametric tests were used as required. Results: In our study, 1,100 neonates, suspected of sepsis, were evaluated. Of all neonates, 28.3% and 71.7% were older and younger than 3 days, respectively. Male-to-female ratio was 1:5 in 115 neonates. Sepsis was confirmed by positive blood culture, and 21 neonates (2.1%) had positive cerebrospinal fluid (CSF), which was significantly associated with blood culture results. Conclusion: There was a significant relationship between blood culture and CSF culture results. However, regarding the low incidence of positive CSF, LP should be performed for each case, based on clinical manifestations and clinical opinion.

Epidemiological Study of Neonatal Bacterial Meningitis: Moroccan Data

Neonatal bacterial meningitis has a mortality rate that exceeds 10% and is responsible for sequelae in 20-50% of cases. The epidemiology of bacterial meningitis is variable depending on the age, areas and periods. Aim of the study: To study the incidence of neonatal meningitis, know the evolution of bacterial epidemiology and risk factors. Population and methods: A retrospective study about 60 cases of neonatal meningitis over a period of 3 years (January 2011-December 2013) at the National Reference Centre for Nutrition and Neonatology of the Children's Hospital of Rabat. Results: The prevalence of neonatal bacterial meningitis was 0.5 per 1000 live births. Parturients were aged between 21 and 35 years in 50% of cases. They were illiterate in 65% of cases. The pregnancies were followed in 60% of cases. Families were from urban environment in 70% of cases. Primiparity was noted in 69% of mothers. We had vaginal delivery in 80% of women. The Apgar was <7 to 20% of newborns. The average age was 4 days with extremes of 2 and 23 days. The sex ratio was 1. Were preterm children in 42% of cases of low birth weight in 93% of cases. The average age at diagnosis was 2 day +/- 1. Neonatal bacterial meningitis were due to Escherichia coli in 45% of cases followed by group B streptococcus (GBS), which represents 2% of germs involved. Blood culture was positive in 60% of patients. They were congenital anomalies associated in 13% of cases. Low birth weight, failure monitoring pregnancy and the presence of congenital malformations were risk factors significantly associated with the occurrence of neonatal bacterial meningitis. The death occurred in 8% of cases. Conclusion: Neonatal bacterial meningitis was significantly related to adverse socio-economic conditions.

High Likelihood of Meningitis with Late Onset Septicemia in Newborn

Neonatal meningitis must be recognized and treated quickly to prevent death or disability. Incidence of neonatal meningitis with late onset sepsis is higher in developing countries than those of resource-rich countries. In neonates signs and symptoms of serious infections are often obscured and clinical examination cannot distinguish among septic babies with or without meningitis. Clinicians often differ whether neonates undergo lumber puncture or not to distinguish septic babies with or without meningitis. Abnormal CSF findings are often used to detect neonatal meningitis and determine the type and length of antibiotic therapy with proven sepsis and meningitis cases. This study was conducted to evaluate the bacterial meningitis among the late onset sepsis in newborns and to identify the clinical manifestations that can distinguish septicemia from meningitis in neonates. Total 1706 admitted patient in NICU of Bangabandhu Sheikh Mujib Medical University from January 2007 to December 2009 were evaluated retrospectively. Among the 133 (27.94%) cases of suspected late onset sepsis 47(35.33%) were proven sepsis, 63(47.37%) were probable sepsis and 23(17.29%) cases were clinical sepsis based on clinical features laboratory reports and blood cultures. Among the proven sepsis 12(42.85%) cases were found to have definitive bacterial meningitis and 16(57.15%) were probable bacterial meningitis. Among the provable sepsis only 1(12.50%) cases were found to have definite bacterial meningitis and 7 (87.50%) cases were probable bacterial meningitis. There were no meningitis have found among the clinical sepsis. Neonatal meningitis frequently occurred in late onset sepsis. The most frequent presenting clinical features for meningitis cases are more or less similar to those of septicemic cases. The data of the study suggest that newborns with a positive blood culture are significantly more likely to have meningitis than those with a negative blood culture. DOI: http://dx.doi.org/10.3329/jbcps.v30i1.11362 J Bangladesh Coll Phys Surg 2012; 30: 17-23

Neonatal meningitis in England and Wales: 10 years on

OBJECTIVESTo determine the incidence of neonatal meningitis in England and Wales.DESIGNA national postal survey using the British Paediatric Surveillance Unit (BPSU) card scheme supplemented by information from other sources.SETTINGEngland and...

Neonatal meningitis: mortality, cerebrospinal fluid, and microbiological findings.

This study describes the bacteriology, cerebrospinal fluid (CSF) findings, and mortality of neonatal meningitis over an 11-year period. The minimum incidence of neonatal meningitis at Tygerberg Hospital is 0.72/1000 live births/year. Eighty-eight patients were included in the study. Median birthweight and age at diagnosis were 2320 g and 12 days, respectively. CSF culture was positive in 77 (88 per cent), blood culture was positive in 51 (57 per cent), and Gram stain was positive in 58 (66 per cent). The most frequently cultured organisms were Group B Streptococcus, Klebsiella pneumoniae, and E. coli. Thirty (34 per cent) patients died, the majority within 72 h after admission. The death rate was significantly increased in babies with a birthweight of less than 1500 g (59 per cent). Increased total CSF protein was associated with an increased risk of death. Normal CSF cell count, total CSF protein and CSF glucose were found in six infants.

Analyse rétrospective de 1331 échantillons de liquide céphalorachidien chez le nouveau-né suspect d'infection

Background. - Definitive diagnosis of a neonatal infection usually requires recovery of an etiologic agent from body fluids or tissues such as spinal fluid, blood and urine. Routine lumbar puncture (LP) may raise some problems in interpreting results. Population and methods. - A retrospective analysis of 1331 samples of CSF was made. LP had been performed on 1041 neonates including 569 prematures (54.6%) as a part of the evaluation for suspected bacterial infection. Results. - In 50.7% of the cases, the CSF was haemorrhagic. The frequency of traumatic taps increased with the degree of prematurity, low birth weight, precocity of LP, association with respiratory distress and disorders of coagulating factors. In addition, haemorragic taps modified biochemical and cytologic characteristics of CSF. One hundred and six (8%) CSF samples contained organisms but the diagnosis of meningitis was certain in only 23 cases (2.2%). In the other 83 cases, CSF was thought to be contaminated, mostly by coagulase-negative staphylococci. Since both blood and CSF cultures were positive for the same bacterial organism in 18 cases, it was concluded that the LP had been useful in identifying the pathogens in only five cases. The high frequency of contaminated CSF led to overestimation of the incidence of true bacterial meningitis (0.57% in our study). Conclusions. - The low incidence of meningitis in neonates, the risk of having an haemorragic tap associated with the possibility of clinical aggravation during LP and the fact that the same pathogen is frequently (78.2% of cases) identified in blood cultures suggest that the immediate and routine LP is of less value than expected in infants suspected to be infected. LP could be postponed when the neonate presents with a respiratory distress syndrome and/or a precarious haemodynamic state.

Acute bacterial meningitis in the newborn

Acute bacterial meningitis is more common during the neonatal period than at any other time of life and is accompanied by a high incidence of mortality and long term significant sequelae. The incidence of neonatal meningitis is variously calculated at between 0.25 and 0.32 per 1000 live births depending on the inclusion criteria. There is no evidence that the incidence has changed during the last 25 years although during this time there have been dramatic changes in the neonatal population. The pathogenesis of neonatal meningitis is complex and not fully understood. The range of bacteria involved is wider than in paediatric meningitis. Mortality rates are highest following infection with enteric Gram-negative bacilli, and still exceed 30%, lower with the Lancefield group B streptococcus and lower still with other Gram-positive bacteria. The predisposing factors to neonatal meningitis are few with the exception of maternal infection or pyrexia at the time of delivery. Any association between meningitis and other possible predisposing factors has not been reliably established. There is evidence to suggest that meningitis in premature low birth weight and sickly babies is caused by organisms, usually from the maternal genital tract, which do not have recognized pathogenicity factors. In contrast, late onset infection is associated with organisms with recognized virulence and pathogenicity factors, many of which have a predisposition to the central nervous system. The clinical presentation of neonatal meningitis is non-specific and meningitic babies cannot be easily distinguished from those with other septic foci or sick uninfected babies. In consequence appropriate antibiotic therapy must be initiated as soon as meningitis is suspected. It is currently recommended that neonatal meningitis is treated with a third-generation cephalosporin, cefotaxime or ceftriaxone, with or without an aminoglycoside, usually gentamicin or amikacin. If there is a significant risk of infection with listeria or enterococci then ampicillin should also be given until CSF culture results are available. While steroids are extensively used for the treatment of paediatric meningitis there is no evidence to support their use in the treatment of neonatal infection. New therapeutic regimens are being developed which are intended to alleviate the pathophysiological consequences of endotoxin release which follows the administration of antibiotics.(ABSTRACT TRUNCATED AT 400 WORDS)

Prospective surveillance of neonatal meningitis.

Neonatal meningitis is a serious problem with a high mortality and frequent neurological sequelae. The incidence of neonatal meningitis was calculated and the aetiology, clinical and laboratory features, and the treatment of cases recorded prospectively over a 7 year 8 month period was documented. It was further investigated whether secondary meningitis had occurred after lumbar puncture. The estimated incidence of bacterial, viral, and fungal meningitis was 0.25, 0.11, and 0.02 per 1000 live births respectively. There were eight cases of early onset meningitis (seven definite, one probable) and group B streptococci accounted for six (75%) of these. Blood cultures were negative in only one of seven cases of definite early bacterial meningitis. Of the 15 late onset cases, Gram negative organisms accounted for six of the seven bacterial cases. The overall mortality was 26%. Of the 11 survivors of bacterial meningitis, three (27%) had significant neurological sequelae at follow up (between three months to three years later). As in the first 48 hours after birth an initial blood culture is unlikely to be negative if bacterial meningitis is present, lumbar puncture can be deferred if the procedure might exacerbate respiratory distress. Although approximately 1880 infants had a lumbar puncture during the review period, only one case of meningitis was found where it was possible that lumbar puncture in a bacteraemic infant may have caused meningeal infection. The incidence of this potential complication must therefore be low.