Predictors of Mortality in Acute Bacterial Meningitis in Outborn Neonates with Late Onset Sepsis

Abstract

ABSTRACT Introduction: Neonatal bacterial meningitis (NBM) is the most devastating complication of late-onset sepsis with incidence ranging from 12.5% to 61.11% with a mortality rate of 16-45.5% and disability rate of 25-50%. Objectives: To estimate the clinical and laboratory predictors of mortality in outborn neonates with NBM. Methods: A prospective observational study was carried out on 150 outborn neonates with late-onset sepsis and with clinically diagnosed meningitis; and CSF biochemical abnormalities with or without CSF culture positivity at a tertiary care teaching hospital in central India over a period of 2 years. Data on demographic, maternal, neonatal, and socio-cultural factors were recorded and analyzed using a univariate and multiple regression model. Results: Distance travelled more than 150 km (OR 1.01, CI 1.0-1.02, P = 0.04), transport duration >3 hrs (OR 4.58, CI 2.07-10.11, P < 0.0001), premature rupture of membrane >24 hours (OR 9.68, CI 2.14-43.70, P < 0.0001), transaminitis (SGPT >40IU/L) (OR 0.93, CI 0.88-0.97, P < 0.003), CSF turbidity (OR 16.70, CI 4.45-62.70, P < 0.0001), raised CSF protein (OR 8.81, CI 1.45-53.34, P = 0.018), and low CSF sugar (OR 20.48, CI 4.18-100.26, P < 0.0001) were independent predictors of mortality in neonatal meningitis on multivariate analysis. Conclusion: Anticipation, early recognition, and prompt treatment of maternal, neonatal, socio-cultural, and laboratory risk factors are important to reduce the mortality of devastating complication of late-onset sepsis.