title: Factors for poor prognosis of neonatal bacterial meningitis in a medical center in Northern Taiwan.
abstract: BACKGROUND
  Bacterial meningitis has long been a severe infectious disease in neonates, as well as a leading cause of adverse outcomes. We designed this study to know the factors for poor prognosis in neonatal bacterial meningitis.
  
  
  METHODS
  We enrolled children aged less than 1 month who were admitted to Mackay Memorial Hospital from 1984 to 2008 and had culture-proven bacterial meningitis. The laboratory data and children's clinical features were recorded. The patients' outcomes were divided into four groups: death, having sequelae, complete recovery, and loss to follow-up. Patients with the outcomes of death and having sequelae were regarded as having a poor prognosis. Those who were lost to follow-up were excluded from the analysis of outcome. Multivariate analyses were performed to find the risk factors for poor prognosis.
  
  
  RESULTS
  One hundred fifty-six neonates fulfilled the inclusion criteria. Among these, 96 were boys (61.5%) and 102 (65.4%) had concomitant bacteremia. Group B streptococci (39.1%) and Escherichia coli (20.1%) were the two leading pathogens. Excluding those who were lost to follow-up (4.5%), 22 of 149 patients (14.8%) died, 36 (24.2%) had sequelae, and 91 (61.1%) recovered completely. Cerebrospinal fluid (CSF) protein more than 500 mg/dL at admission {odds ratio (OR): 171.18 [95% confidence interval (CI): 25.6-1000]}, predisposition to congenital heart disease [OR: 48.96 (95% CI: 6.06-395.64)], hearing impairment found during hospitalization [OR: 23.40 (95% CI: 3.62-151.25)], and seizure at admission or during hospitalization [OR: 10.10 (95% CI: 2.11-48.32)] were the factors predicting poor prognosis.
  
  
  CONCLUSIONS
  In this 25-year study of newborns with bacterial meningitis, approximately one-seventh of the patients died, while two-fifths had sequelae. Nearly two-thirds of these had concomitant bacteremia. Group B streptococci and E. coli remained the two leading pathogens throughout the study period. Several factors for poor prognosis in newborns with culture-proven bacterial meningitis were found: high CSF protein concentration, congenital heart disease, hearing impairment, and seizure.
authors.affiliation: Department of Pediatrics, Mackay Memorial Hospital, Taipei, Taiwan.
authors.forename: Mu-Chun
authors.initials: MC
authors.lastname: Lin
authors.forename: Hsin
authors.initials: H
authors.lastname: Chi
authors.forename: Nan-Chang
authors.initials: NC
authors.lastname: Chiu
authors.forename: Fu-Yuan
authors.initials: FY
authors.lastname: Huang
authors.forename: Che-Sheng
authors.initials: CS
authors.lastname: Ho
mesh_terms: D002675:Child, Preschool; D004926:Escherichia coli / Q000302:isolation & purification*; D005260:Female; D006760:Hospitalization; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D016920:Meningitis, Bacterial / Q000134:cerebrospinal fluid / Q000150:complications / Q000175:diagnosis* / Q000382:microbiology; D020814:Meningitis, Escherichia coli / Q000134:cerebrospinal fluid / Q000150:complications / Q000175:diagnosis* / Q000382:microbiology; D011379:Prognosis; D012307:Risk Factors; D013292:Streptococcus agalactiae / Q000302:isolation & purification*; D013624:Taiwan