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Epidemiology of Meningitis in Canadian Neonatal Intensive Care Units

El-Naggar, Walid, MD*; Afifi, Jehier, MD*; McMillan, Douglas, MD*; Toye, Jennifer, MD; Ting, Joseph, MBBS, MPH; Yoon, Eugene W., MSc§; Shah, Prakesh S., MD§,¶ on behalf of the Canadian Neonatal Network Investigators‖

The Pediatric Infectious Disease Journal: May 2019 - Volume 38 - Issue 5 - p 476–480
doi: 10.1097/INF.0000000000002247
Original Studies
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Background: Meningitis is a serious disease that occurs more commonly in the neonatal period than in any other age group. Recent data from large national cohorts are needed to determine if the epidemiology of neonatal meningitis (NM) has changed.

Aim: To assess the rates, causative organisms, risk factors, temporal trends and short-term outcomes of NM in Canadian Neonatal Intensive Care Units (NICUs).

Methods: A retrospective review of newborn infants admitted to NICUs participating in the Canadian Neonatal Network between January 2010 and December 2016. Patients with meningitis were reviewed. Outcomes of patients with meningitis were compared with 1:2 matched (for gestation, sex and birth weight) neonates without meningitis.

Results: Rates of NM ranged between 2.2 and 3.5/1000 NICU admissions during the 7-year study period with the majority of patients (87%) having late-onset meningitis (at >3 days after birth). The most common bacterial organism for both early- and late-onset meningitis was Escherichia coli followed by group B streptococci. Only 31% [95% confidence interval (CI): 24.06–38.63) of neonates with meningitis had simultaneous bacteremia. NM was associated with increased seizures [odds ratio (OR): 8.63; 95% CI: 4.73–15.7], retinopathy of prematurity (OR: 3.23; 95% CI: 1.30–8.02), bronchopulmonary dysplasia (OR: 1.93; 95% CI: 1.11–3.35), days of mechanical ventilation (OR: 1.03; 95% CI: 1.02–1.04) and length of hospital stay (OR: 1.02; 95% CI: 1.01–1.02), but not with mortality before discharge (OR: 1.29; 95% CI: 0.74–2.23).

Conclusions: The rate of NM remains largely unchanged in Canadian NICUs. NM was associated with increased major morbidities and longer hospital stay but not with mortality before discharge.

From the *Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada

Division of Neonatology, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada

Division of Neonatology, Department of Pediatrics, University of British Colombia, Vancouver, British Colombia, Canada

§Maternal-Infant Care (MiCare) Research Centre, Mount Sinai Hospital

Department of Pediatrics, University of Toronto, Toronto, Ontario Canada.

Accepted for publication October 16, 2018.

Organizational support was provided by the Canadian Neonatal Network Coordinating Centre, which is based at the Maternal-Infant Care Research Centre at Mount Sinai Hospital in Toronto, Ontario, Canada. MiCare is supported by grant funding from the Canadian Institutes of Health Research (FRN87518) and in kind support from Mount Sinai Hospital, Toronto, Ontario. J.T. is supported by the Investigator Grant Award Program from British Columbia Children’s Hospital Research Institute. P.S.S. holds an applied research chair in Reproductive and Child Health Services and Policy Research awarded by the Canadian Institutes of Health Research (APR-126340). The other authors have no conflicts of interest to disclose.

A complete listing of the Canadian Neonatal Network Investigators can be found in the Acknowledgments (See Supplemental Digital Content 1, http://links.lww.com/INF/D373 for acknowledgments and investigators).

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 (http://journals.lww.com/ccmjournal).

Address for correspondence: Walid El-Naggar, MD, Division of Neonatal-Perinatal Medicine, Department of Pediatrics, IWK Health Centre, Dalhousie University, 5850/5980 University Ave., PO Box 9700, Halifax, NS B3K 6R8, Canada. E-mail: walid.el-naggar@iwk.nshealth.ca.

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