Clinical Characteristics and Risk Factors for Poor Outcome in Infants Less Than 90 Days of Age With Bacterial Meningitis in the United Kingdom and Ireland

Ifeanyichukwu O. Okike*, Shamez N. Ladhani, Alan P. Johnson, Katherine L. Henderson, Ruth M. Blackburn, Berit Muller-Pebody, Mary Cafferkey, Mark Anthony, Nelly Ninis, Paul T. Heath

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

10 Citations (Scopus)

Abstract

Background: To describe the clinical characteristics and risk factors associated with poor outcome in infants <90 days of age with bacterial meningitis. Methods: Prospective, enhanced, national population-based active surveillance for infants <90 days of age with bacterial meningitis in the United Kingdom and Ireland between July 2010 and July 2011. Infants were identified through the British Paediatric Surveillance Unit, laboratory surveillance and meningitis charities. Results: Clinical details was available for 263 of 298 (88%) infants where a bacterium was identified, 184 (70%) were born at term. Fever was reported in 143 (54%), seizures in 73 (28%), bulging fontanelle in 58 (22%), coma in 15 (6%) and neck stiffness in 7 (3%). Twenty-three (9%) died and 56/240 (23%) of the survivors had serious central nervous system complications at discharge. Temperature instability [odds ratio (OR), 2.99; 95% confidence interval (CI): 1.21–7.41], seizures (OR, 7.06; 95% CI: 2.80–17.81), cerebrospinal fluid protein greater than the median concentration (2275 mg/ dL; OR, 2.62; 95% CI: 1.13–6.10) and pneumococcal meningitis (OR, 4.83; 95% CI: 1.33–17.58) were independently associated with serious central nervous system complications while prematurity (OR, 5.84; 95% CI: 2.02–16.85), low birthweight (OR, 8.48; 95% CI: 2.60–27.69), coma at presentation (OR, 31.85; 95% CI: 8.46–119.81) and pneumococcal meningitis (OR, 4.62; 95% CI: 1.19–17.91) were independently associated with death. Conclusions: The classic features of meningitis were uncommon. The presentation in young infants is often nonspecific, and only half of cases presented with fever. A number of clinical and laboratory factors were associated with poor outcomes; further research is required to determine how knowledge of these risk factors might improve clinical management and outcomes.

Original languageEnglish
Pages (from-to)837-843
Number of pages7
JournalPediatric Infectious Disease Journal
Volume37
Issue number9
DOIs
Publication statusPublished - 1 Sep 2018

Bibliographical note

Funding Information:
This work was supported by Meningitis Research Foundation grant number 0804.0. The funding organization played no part in the design and conduct of the study; collection, management, analysis and interpretation of the data; preparation, review or approval of the manuscript and decision to submit the manuscript for publication.

Publisher Copyright:
Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

Keywords

  • Antibiotics
  • British Paediatric Surveillance Unit
  • Central nervous system complications
  • Clinical features
  • Infant
  • Management
  • Meningitis
  • Neonate

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