Long-term outcome of neonatal meningitis
S. M. Franco, V. E. Cornelius and B. F. Andrews
Department of Pediatrics, University of Louisville, Ky.
OBJECTIVE--To determine the long-term outcome of neonatal bacterial
meningitis and the relationship between the outcome and specific features
in the acute stage of the disease; and to compare the outcome between
infants with neonatal meningitis and high-risk infants without meningitis.
DESIGN--Prospective clinical evaluations of 21 survivors of meningitis and
21 matched controls who were retrospectively selected from a high-risk
patient population. SETTING--Program of follow-up performed at the Children
and Youth Project's High Risk Center of the Department of Pediatrics,
University of Louisville, Louisville, Ky. Neonates were inborn at a
university hospital with a high-risk obstetric unit and level III nursery.
PATIENTS--Twenty-six consecutive neonates born between 1970 and 1980 with
culture-proven bacterial meningitis, excluding neonates with congenital
neurologic defects. Nineteen of 21 survivors and 21 controls matched by
age, sex, race, birth weight, and gestational age were followed up from 1
to 14 years (mean, 7.8 years). Both survivors and controls fell below the
federal poverty guidelines. RESULTS--Gram-positive meningitis was twice as
common as gram-negative meningitis with co-occurrence of meningitis and
sepsis in half of the cases. Neonates with gram-positive meningitis and
higher birth weight had a higher survival rate, but this finding was not
statistically significant. The mortality rate in neonates with
gram-negative meningitis was almost three times higher than that of
neonates with gram-positive meningitis, but no significant difference was
observed between their morbidity rates. Eight (38%) of 21 survivors were
normal, while another eight (38%) and five (24%) had mild and moderate to
severe sequelae, respectively. Survivors of meningitis had lower IQ scores
and more severe sequelae than matched controls. CONCLUSION--Neonatal
bacterial meningitis results in poorer long-term outcome than in controls,
but improved outcome compared with previous studies of neonatal meningitis.
