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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

Okike, Ifeanyichukwu O., MD, PhD*,†; Ladhani, Shamez N., MD, PhD‡,§; Johnson, Alan P., PhD; Henderson, Katherine L., PhD; Blackburn, Ruth M., PhD; Muller-Pebody, Berit, PhD; Cafferkey, Mary, FRCPI; Anthony, Mark, MD, PhD**; Ninis, Nelly, MD††; Heath, Paul T., FRCPCH* for the neoMen Study Group

The Pediatric Infectious Disease Journal: September 2018 - Volume 37 - Issue 9 - p 837–843
doi: 10.1097/INF.0000000000001917
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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.

From the *Vaccine Institute & Institute for Infection and Immunity, St George’s, University of London and St Georges University Hospitals NHS Trust, London, United Kingdom

Healthcare Associated Infections & Antimicrobial Resistance Department

Immunisation, Hepatitis and Blood Safety Department, National Infection Service, Public Health England, London, United Kingdom

§Institute for Infection and Immunity, St George’s University of London, London, United Kingdom

Institute for Health Informatics Research, University College, London, United Kingdom

The Health Protection Surveillance Centre, Dublin, Ireland

**John Radcliffe Hospital, Oxford, United Kingdom

††St Mary’s Hospital, Paddington, London, United Kingdom.

Accepted for publication October 27, 2017.

Members of the NeoMen study and affiliations are listed in the Acknowledgement section.

The corresponding author and the Chief Investigator (most senior author) both have full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

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.

P.T.H. is an investigator for clinical trials done on behalf of St George’s, University of London, United Kingdom, sponsored by vaccine manufacturers. P.T.H. is a consultant to Novartis and Pfizer on group B streptococcus vaccines but receives no payment for this. N.N. is a consultant to Pfizer on Meningococcal Group B vaccines and has received honoraria to teaching on meningitis from Novartis. All other authors declare no conflicts of interests. The International Committee of Medical Journal Editors (ICMJE) Form for Disclosure of Potential conflicts of Interest will be submitted.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (www.pidj.com).

Address for correspondence: Ifeanyichukwu O. Okike, MD, PhD, Vaccine Institute & Institute for Infection and Immunity St George’s, University of London, SW17 0RE, London, United Kingdom. E-mail: ifyokike@yahoo.com or iokike@sgul.ac.uk.

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