Predicting the outcome of neonatal bacterial meningitis.
OBJECTIVE
To build predictive models of severe adverse outcome at various times in the course of neonatal bacterial meningitis.


METHODS
Retrospective cohort study with follow-up to a minimum age of 1 year of term and near-term infants, admitted between 1979 and 1998 to a regional tertiary care center. Predictors of adverse outcome detectable at 1 year of age (death or moderate or severe neurosensory impairment) were identified by univariate analysis. Independent predictors of adverse outcome were identified by multivariate analysis. Predictive tree models were constructed at 12, 24, 48, and 96 hours after admission and at discharge.


RESULTS
Of 101 infants admitted with definitive bacterial meningitis, 13 died and 17 had moderate or severe disability at 1 year of age. Outcomes are known for all patients, to 1 year of age. Twelve hours after admission the important predictors of adverse outcome were presence of seizures, presence of coma, use of inotropes, and leukopenia (sensitivity: 68%; specificity: 100%). At 96 hours the predictors were seizure duration of >72 hours, presence of coma, use of inotropes, and leukopenia (sensitivity: 88%; specificity: 99%).


CONCLUSIONS
Most infants at risk for adverse outcome can be identified within 12 hours of admission. Duration of seizures for >72 hours, presence of coma, use of inotropes, and leukopenia were the most important predictors of adverse outcome. Although these models have good predictive accuracy, they need to be validated in a contemporary cohort in large multicenter studies.
Klinger
G
G
Division of Neonatology, Hospital for Sick Children, Toronto, Ontario, Canada.
Chin
C N
CN
Beyene
J
J
Perlman
M
M
D006801:Humans; D007231:Infant, Newborn; D016920:Meningitis, Bacterial / Q000150:complications* / Q000401:mortality*; D008962:Models, Theoretical; D017063:Outcome Assessment, Health Care; D011379:Prognosis; D018570:Risk Assessment; D012307:Risk Factors; D016019:Survival Analysis