Incidence of meningitis in late onset sepsis

Roshi Bhagat, Sheikh Quyoom Hussain, Imran Ahmad Gattoo, Shabir Ahmed Wani

Abstract


Background: Bacterial sepsis and meningitis continue to be major causes of morbidity and mortality in newborns, particularly in premature infants. The present study was undertaken to know the incidence of meningitis in neonates with late onset sepsis.

Methods: Hospital based observational study, conducted in the post graduate department of pediatrics, government medical college, Srinagar, conducted for a period of one year. 423 patients fulfilling the inclusion criteria were included and subjected to detailed history, clinical examination followed by investigations.

Results: The annual incidence of meningitis in LOS was 16. The majority of patients (46.1%) presented in the age group of 3-7 days. The mean weight of neonates was 2.61 ± 0.606) kg. 60.3% of neonates with meningitis were of low birth weight (P <0.005). 61.7% of preterms with LOS had meningitis as against 38.2% for terms (P <0.005). 57.4% males had meningitis as against 42.6% females (P >0.005). In meningitis cases 100% cases were lethargic; seizures in 92.8%, fever in 50%. Blood culture was positive in 42.6% cases of meningitis. Meningitis was seen in 60.7% of proven gram negative sepsis as against 30.7% cases of proven gram positive sepsis (P <0.005). 94.5% of the exclusively breast fed neonates with meningitis recovered  and 6.3%  expired whereas for the other feeding group the corresponding figures were 77 % and 22.4 % respectively (P <0.005). 17.6% cases of meningitis had mortality as against 4.8% in those who had sepsis but no meningitis (P <0.005).

Conclusions: Meningitis is common in late onset sepsis, associated with high mortality, with a beneficial effect from exclusive breast feeding. 


Keywords


Meningitis, Preterm, LBW, Lumber puncture, Breast feeding

Full Text:

PDF

References


Bang AT, Bang RA, Bactule SB, Reddy HM, Deshmukh MD. Effect of home based neonatal care and management of sepsis on neonatal mortality; field trial in rural India. Lancet. 1999;354:1955-86,

Vergnano S, Sharland M, Kazembe P, Mwansambo C, Heath PT. Neonatal sepsis: an international perspective. Arch Dis Child Fetal Neonatal Ed. 2005;90:F220-4.

Deorari AK. Changing pattern of bacteriological profile in neonatal sepsis among intramural babies. J Neonatol. 2006;20(1):8-15.

Mathur NB, Khalil A, Sarkar R, Puri RK. Mortality in neonatal septicaemia with involvement of mother in management. Indian Pediatr. 1991;28:1259-63.

Kristof K, Kocsis E, Nagy K. Clinical Microbiology of early onset and late onset sepsis, particularly among preterm babies. Acta Microbiologica et Immunologica Hungarica. 2009;56(1):21-51.

National Neonatal-Perinatal Database (NNPD). Report of the national neonatal perinatal database (National neonatology forum), 2002-2003. Available at: http://www.newbornwhocc.org/pdf/nnpd_report_2002-03.PDF. Accessed January 2005.

Jeevashankar M, Agarwal R, Deorari AK, Paul VK. Sepsis in new-born. Indian J Pediatr. 2008;75(3):261-6.

Issacs D, Barfield C, Clothier T, Darlow B, Diplock R, Ehrlich J, et al. Late onset infections of infants in neonatal units. J Paediatr Child Health. 1996;32:158-61.

Stoll BJ, Hansen N, Fanaroff AA, Wright LL, Carlo WA, Ehrenkranz RA, et al. Late onset sepsis in very low birth weight neonates: the experience of the NICHD Neonatal Research Network. Pediatrics. 2002;110:285-91.

Stoll BJ, Hansen N, Fanaroff AA, Wright LL, Carlo WA, Ehrenkranz RA, et al. Changes in pathogens causing early onset sepsis in very low birth weight infants. N Engl J Med. 2002;347:240-7.

Baltimore RS. Late onset infections in the nursery. Yale J Biol Med. 1988;61:501-6.

Bizzaro M, Raskind C, Baltimore R, Gallagher PG. Seventy five years of neonatal sepsis at Yale: 1928-2003. Pediatrics. 2005;116:595-602.

Gladstone IM, Ehrenkrantz RA, Edberg SC, Baltimore RS. A ten year review of neonatal sepsis and comparison with the previous fifty year experience. Pediatr Infect Dis J. 1990;9:819-25.

Ronnestad A, Abrahamsen TG, Ganstad P, Finne PH. Blood culture isolates during six years in a tertiary neonatal intensive care unit. Scand J Infect Dis. 1998;30:245-51.

Ronnestad A, Abrahamsen TG, Medbo S, Reigstad H, Lossius K, Kaaresen PI, et al. Septicemia in the first week of life in a Norwegian National cohort of extremely premature infants. Pediatrics. 2005;115:e262-8.

Tessin I, Trollfors B, Thiringer K. Incidence and etiology of neonatal septicemia and meningitis in Western Sweden 1975-1986. Acta Paediatr Scand. 1990;79:1023-30.

Vesikari T, Isolauri E, Tuppurainen N, Renlund M, Koivisto M, Janus M. Neonatal septicemia in Finland 1981-1985. Acta Paediatr Scand. 1989;78:44-50.

Baltimore RS. Neonatal nosocomial infections. Semin Perinatal. 1998;22:25-32.

Gerdes JS, Polin R. Early diagnosis and treatment of neonatal sepsis. Indian J Pediatr. 1998;65:63-78.

Makhoul IR, Sujov P, Smolkin T, Lusky A, Reichman B. Epidemiological, clinical and microbiological characteristics of late onset sepsis among very low birth weight infants in Israel: a national survey. Pediatrics. 2002;109:34-9.

Tseng YC, Chiu YC, Wang JH, Lin HC, Lin HC, Su BH, et al. Nosocomial blood stream infections in a neonatal intensive care unit of a medical care centre: a three year review. J Microbiol Immunol Infect. 2002;35:168-72.

Berger A, Salzer HR, Weninger M, Sageder B, Aspöck C. Septicemia in an Austrian neonatal intensive care unit: a 7 year analysis. Acta Paediatr. 1998;87:1066-9.

Schwersenski J, Mcintyre L, Bauer C. Lumbar puncture frequency and cerebrospinal fluid analysis in the neonate. Am J Dis Child. 1991;145:54-8.

Malbon K, Mohan R, Nicholl R. Should a neonate with possible late onset infection always has a lumbar puncture? Arch Dis Child. 2006;91:75-6.

Timothy G. Townsend. Infection. In: Timothy G. Townsend, eds. Primary Care of New-born. 4th ed. USA: Elsevier Health; 2006: 360.

Visser VE, Hall RT. Lumbar pucture in neonatal infection. J Pediatr. 1980;96:1063-6.

Laving AM, Musoke RN, Wasunna AO, Revathi G. Neonatal bacterial meningitis at the new-born unit of Kenyatta national hospital. East Afr Med J. 2003 Sep;80(9):456-62.

Anjos da Silva LP, Cavalheiro LG, Queirós F, Nova CV, Lucena R. Prevalence of new-born bacterial meningitis and sepsis during the pregnancy period for public health care system participants in Salvador, Bahia, Brazil. Brazil J Infect Dis. 2007;11(2):272-6.

Tiskumara R, Fakharee SH, Liu CQ, Nuntnarumit P, Lui KM, Hammoud M, et al. Neonatal infections in Asia. Arch Dis Child Fetal Neonatal Ed. 2009 Mar;94(2):F144-8.

Longe AC, Omene JA, Okolo AA. Neonatal meningitis in Nigerian infants. Acta Pediatr Scand. 1984;73:477-81.

Moreno MT, Vargas S, Poveda R, Sáez-Llorens X. Neonatal sepsis and meningitis in a developing Latin American country. Pediatr Infect Dis J. 1994;13:516-20.

Jiang JH, Chiu NC, Huang FY, Kao HA, Hsu CH, Hung HY, et al. Neonatal sepsis in the neonatal intensive care unit: characteristics of early vs. late onset. J Microbial Immunol Infect. 2004;37:301-6.

Gheibi S, Fakoor Z, Karamyyar M, Khashabi J, Ilkhanizadeh B, Farzin Asghari-Sana, et al. Coagulase negative staphylococcus; the most common cause of neonatal septicemia in Urmia, Iran. Iran J Pediatr. 2008 Sep;18(3):237-43.

Hoque MM, Ahmed ASM, Chowdhury MA, Darmstadt GL, Saha SK. Septicemic neonates without lumbar puncture: what are we missing? J Trop Pediatr. 2006;52(1):63-5.

Karthikayen G, Premkumar K. Neonatal sepsis: Staphylococcus aureus as the predominant pathogen. Indian J Pediatr. 2001;68:715-7.

Greenberg D, Shinwell ES, Yagupsky P, Greenberg S, Leibovitz E, Mazor M, et al. A prospective study of neonatal sepsis and meningitis in southern Israel. Pediatr Infect Dis J. 1997 Aug;16(8):768-73.

Sundaram V, Kumar P, Narang A. Bacterial profile of early versus late onset neonatal sepsis in a North Indian tertiary care center: heading towards a change. J Pediatr Infect Dis. 2009;4:241-5.

Zhu ML, Zheng G, Chen JN, Lin ZL, Zhu JH, Lin J. Comparative analysis of the pathogens responsible for hospital acquired and community acquired late onset neonatal septicemia. Zhonghua Er Ke Za Zhi. 2008 Feb;46(2):124-7.

Kuruvilla KA, Pillai S, Jesudason M, Jana AK. Bacterial profile of sepsis in a neonatal unit in south India. Indian Pediatr. 1998;35:851-8.

Khassawneh M, Hayajneh W, Kofahi H, Khader Y, Amarin Z, Daoud A. Diagnostic markers for neonatal sepsis: comparing C-reactive protein, interleukin-6 and immunoglobulin M. Scand J Immunol. 2007;65:171-5.