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Neonatal meningitis

Neonatal meningitis

 The incidence of neonatal bacterial meningitis is 37 per 100,000 in the western world144 and the survival has improved from 80%145 in the mid 1980's to 92%146 in the mid 1990's.  With improving survival it is essential to evaluate the long term outcome in these infants.  A population-based survey of infants from England born between 1987-1989 with neonatal bacterial meningitis showed adverse outcomes at five years of cerebral palsy (9%), epilepsy (7%), sensorineural hearing loss (3%) and learning problems (8%)146.  They noted that moderate or severe impairments occurred in about 18% of the survivors.  A subsequent survey in 1996-1997 by the same group showed that moderate or severe impairments remained high at 23%147.

 In a study from the Montreal Children’s Hospital of newborns born between 1961 and 1970, Fitzhardinge148 noted a mortality of 44% in bacterial meningitis with a disability rate of 46% in the survivors, mainly due to language delays.  She noted an average IQ of 90 which was noticeably worse in gram negative meningitis.  In a recent African study149 neonatal mortality from bacterial meningitis was 33% with a disability rate of 29% including 3 of 7 with cerebral palsy.  This study had a 65% rate of staphylococcus aureus meningitis and not a single case of group B β-haemolytic streptococcus.  A particularly poor outcome of enterobacter meningitis (this was the major pathogen but not the only pathogen) from Brazil was recently reported150.  Of the 55 survivors, 64% had neurological sequelae (severe in 24%) including psychomotor impairments, hydrocephalus and seizures.

 In contrast to the above studies, Franco form the United States151 conducted a case control of infants with bacterial meningitis and found no overall difference in the disability compared to controls.  Franco pointed out that the controls were drawn from a high risk population and thus expected to be at higher risk of adverse outcome.  The abnormalities detected included mental retardation, cerebral palsy, hearing loss and myopia.

 Less information is available about viral meningitis in newborns, however, in a hospital-based study from England, Hristeva152 noted neonatal mortality of 27% (4/15) in bacterial meningitis but 0% (0/6) in viral meningitis.  Long-term disabilities occurred in 27% of survivors with bacterial meningitis but none with viral meningitis.  Baker153 noted that the outcome of enteroviral meningitis was generally good with no deaths and only a slight increase in receptive language delay in the cases compared to controls.  In an outbreak of Coxsackievirus A-14 from a maternity hospital in February 1983154, 16 newborns aged 4-10 days of age developed meningitis.  None died and at the latest follow-up at 9 months showed that none were disabled.  Coxsackie B-5 was also associated with a good outcome155.

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