Predictors of poor outcome in neonates with pyogenic meningitis in a level-three neonatal intensive care unit of developing country

Abstract

Background: The mortality of neonatal pyogenic meningitis is reduced to 10-15%, but morbidity is unchanged. Methods: Primary objective is to determine the outcome, i.e. death or abnormal neurological examination (NE) at discharge and abnormal developmental quotient (DQ) at 3 months. Secondary objective is to find predictors of poor outcome. Results: In all, 89 neonates enrolled, 10 expired and 24 neonates had abnormal NE at discharge. A total of 59 neonates came for follow up, 13 had DQ<70. Prolonged shock (odds ratio, OR: 8.28; p=0.001), coma (OR: 4.3; p=0.001), seizures (OR: 14; p=0.012), mechanical ventilation (OR: 18.55; p=0.00), orogastric feeding (OR: 2.78; p=0.042) and electroencephalography (EEG; OR: 9.6; p=0.00) predicted poor short-term outcome. Abnormal NE at discharge (OR: 15.6; p=0.001), EEG (OR=10.60; p=0.00) and brainstem-evoked reflex audiometry (OR=37.20, p=0.00) predicted a low DQ at 3 months. Mortality and morbidity of neonates with Pyogenic Meningitis (PM) were similar to that in developed countries. Outcome depended on severity of the disease and NE at discharge.