title: [Clinical outcome and prognosis of neonatal bacterial meningitis].
abstract: OBJECTIVE
  To study the epidemiological, clinical, and bacteriological aspects as well as the outcome of neonatal bacterial meningitis and analyze the factors of poor prognosis of this condition.
  
  
  METHODS
  We report a retrospective analysis of 44 cases of neonatal bacterial meningitis hospitalized in the pediatric unit of Tahar Sfar Hospital in Mahdia, Tunisia, between January 1996 and December 2010. Inclusion criteria were infants less than 29 days of age who were hospitalized for bacterial meningitis diagnosed on either the presence of bacteria in cerebrospinal fluid or with more than 50 cells/mm(3), predominance of neutrophils, and the protein level greater than 1.2g/l. Clinical data were obtained through the analysis of patient files. Statistical analysis was based on the Chi(2) test, and P-values less than 0.05 were considered statistically significant.
  
  
  RESULTS
  The incidence of neonatal bacterial meningitis was 0.49 per 1000 live births. The patients were premature in 20.4 % and low birth weight in 13.6 % of cases. The clinical presentation was not specific for most cases. The main signs at admission were hyperthermia (43.2 %), refusal to nurse (20.4 %), seizures (18.2 %), and respiratory distress (13.6 %). The cerebrospinal fluid culture was positive in 36.4 % of cases. The group B streptococcus was the most frequently isolated (62.5 %) followed by Escherichia coli (12.5 %). The association of cefotaxime-ampicillin-gentamicin was used as the first treatment in all cases. Ofloxacin was associated with initial antibiotic therapy during the first 5 days in 20.4 % of cases. The mortality rate was 15.9 % and the rate of neurological sequelae in survivors was 21.6 %. Prematurity, low birth weight, shock, respiratory distress, and pleocytosis of less than 500 cells/mm(3) were the main factors of a poor prognosis. The addition of ofloxacin to the initial antibiotic therapy was associated with a decreased rate of neurological sequelae in survivors (11 % vs. 25 %, P=0.042).
  
  
  CONCLUSIONS
  This study emphasizes the severity of neonatal bacterial meningitis with high rates of mortality and neurological sequelae, especially in premature and low birth weight infants. An early diagnosis and effective antibiotic therapy is needed to improve the prognosis.
authors.affiliation: Unité de néonatologie, service de pédiatrie, hôpital Tahar Sfar, 5111 Mahdia, Tunisie. hechmi.benhamouda@rns.tn
authors.forename: H
authors.initials: H
authors.lastname: Ben Hamouda
authors.forename: A
authors.initials: A
authors.lastname: Ben Haj Khalifa
authors.forename: M A
authors.initials: MA
authors.lastname: Hamza
authors.forename: A
authors.initials: A
authors.lastname: Ayadi
authors.forename: H
authors.initials: H
authors.lastname: Soua
authors.forename: M
authors.initials: M
authors.lastname: Khedher
authors.forename: M T
authors.initials: MT
authors.lastname: Sfar
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D007230:Infant, Low Birth Weight; D007231:Infant, Newborn; D007234:Infant, Premature; D007964:Leukocytosis / Q000453:epidemiology; D008297:Male; D016920:Meningitis, Bacterial / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D011379:Prognosis; D012127:Respiratory Distress Syndrome, Newborn / Q000453:epidemiology; D012189:Retrospective Studies; D012769:Shock / Q000453:epidemiology; D014416:Tunisia / Q000453:epidemiology
chemical_list: D000900:Anti-Bacterial Agents