Clinical Presentation, Laboratory Analysis and Linear Growth in 50 Neonates and Young Infants With Acute Meningitis: One Year Experience of a Single Center in Qatar

Abstract

Abstract
 Introduction: Meningitis occurs frequently in neonates and can lead to a number of acute, severe complications and long-term disabilities. Although, long term growth delay and abnormal weight gain appear to be risk factors following an acute attack of both bacterial and aseptic meningitis in children, especially during the fast phase of infantile growth, the long-term effects of acute meningitis occurring during the neonatal and early infantile periods on linear growth (length, weight and head growth) have not fully reported. 
 Aim of the study: The objective of this study is to describe the clinical presentation of neonates and young infants with acute meningitis with different etiologies and to determine the clinical impact of the effect of acute meningitis on growth parameters. 
 Material and methods: We analyzed the clinical data and the growth parameters of 50 newborns and young infants (age: 1.6 ± 0.9 month) admitted to our hospital (Al Wakhra Hospital, Department of Pediatrics, Doha ,Qatar), between 1-1-2016 to 1-1-2017, with acute meningitis. Anthropometric measurements included weight, length, and head circumference. Length SDS (L-SDS) and body mass-index (BMI) were calculated and recorded at every clinic visit, every 3 months for 8 ± 2 months. 
 Results: In this age group of neonates and young infants with acute meningitis fever (84%) and hypoactivity (64%) were the major presenting manifestations. Acute bacterial meningitis (n: 10) was associated with higher morbidity [shock (n: 1), subdural empyema (n: 1) and hydrocephalus (n: 1)]. Cerebrospinal fluid (CSF) examinations showed that infants with bacterial meningitis had significantly higher pleocytosis of mainly polymorphic leukocytes and protein levels, compared to those with aseptic meningitis 
 All infants showed normal linear growth and weight gain during the follow-up period (8 ± 2 months). The annualized growth rate of infants = 25.3 ± 3.5 cm per year. All had normal length standard deviation scores (LSDS) (-0.2 ± 0.9) and none of them had LSDS < -2. All infants had normal BMI (16.7 ± 1.8 kg/m2). Head circumference growth was normal in 49/50 infants (43.8 ± 1.8 cm) at 8 ± 2 months. One infant developed hydrocephalus after GBS meningitis. There was no statistical difference in linear growth between infants with aseptic and bacterial meningitis. 
 Conclusion: Acute bacterial meningitis in newborns and young infants is still associated with considerably high morbidity and complications. Infantile linear growth appears to be normal in all newborns and young infants with both bacterial and aseptic meningitis.
 

Characteristics of Meningitis in Febrile Infants Aged ≤90 Days

“…However, the most common infection of the central nervous system is aseptic meningitis. In a study of young infants with acute meningitis, almost 80% of infants were found to have aseptic meningitis [3]. In our study, 274 patients (31.6%) were diagnosed with meningitis.…”

“…CSF pleocytosis was defined as a CSF WBC count > 22 WBCs/ mm 3 tient was between 4 and 7 weeks of age; and > 5 WBCs/mm 3 if the patient was ≥ 8 weeks old. UTI was diagnosed as a urine culture (collected by urethral catheterization) with more than 100,000 colony-forming units/mL [11].…”

“…plications, and long-term disabilities, ranging from hearing loss to a permanent motor or cognitive impairment [3]. An early diagnosis of meningitis in younger infants is essential for correct treatment so as to reduce mortality and complications.…”

Neonatal Meningitis: How Complicated Can it be?

“…Neonatal meningitis is a severe medical condition in infants that is rapidly fatal if untreated [20]. Mortality is approximately half in developing countries and ranges from 8%-12.5% in developed countries [10].…”

The Clinical Characteristics, Microbiology and Risk Factors for Adverse Outcomes in Neonates with Gram-Negative Bacillary Meningitis

“…Most studies regarding neonatal meningitis focus on the microbiology, epidemiology, clinical manifestations and outcomes of GBS diseases, and fewer studies look at E. coli meningitis [3][4][5][6][7][8][11][12][13]. Little is known about the differences between GBS meningitis and Gram-negative bacillary (GNB) meningitis in neonates, although some studies have found some uncommon GNB species as the cause of neonatal meningitis [11][12][13]. The neurological sequelae and complications after GNB meningitis are supposed to be different from those caused by GBS or other Gram-positive pathogens in neonates and young infants [1,[11][12][13].…”