ABSTRACT
Neonatal bacterial meningitis [NBM] constitutes a major challenge for the increasing incidence and adverse outcome despite new tools in diagnosis and treatment. Neurodevelopment outcomes are the most severe and have to be predicted as early as possible in the course of the disease. This work aimed to study the contribution of some clinical, laboratory, electroencephalographic and ultrasonic procedures for predicting adverse outcomes of NBM, early in the course of the disease. This study included 45 full term newborn infants who were admitted to Neonatal Intensive Care Unit [NICU], Tanta University Hospital, with definitive NBM proved by cerebrospinal fluid [CSF] culture. All patients were subjected to thorough history taking, clinical examination, electroencephalography [EEG], cranial ultrasound Doppler as well as laboratory investigations including; blood culture, CSF culture, total leukocyte count, platelet count, plasma lactate, CSF lactate and CSF glutamate. All these procedures were fulfilled during the first week sf admission. Some cases were re-evaluated for EEG and cranial Doppler. Cases were followed for neurodevelopmental outcome for one year after discharge. The results showed adverse outcomes of cases of NBM at one year age. They revealed blindness, hemiparesis, microcephaly, cerebral palsy [8% for each one], seizures disorders [12%], hearing loss [16%] hydrocephalus [20%] and death [20%]. The most important clinical and laboratory predictors of adverse outcome were the presence of seizures duration > I2 hours [sensitivity 8804 and specificity 85%], coma at presentation [sensitivity 40% and specificity 95%], need for ventilator support [sensitivity 12% and specificity 95%], total leukocyte count <5000/ mm3 [sensitivity 36% and specificity 90%] and platelet count <10[5]/mm3 [sensitivity 40% and specificity 90%]. EEG results showed that EEG background activity and overall EEG description were identified as sensitive predictors of adverse outcome [sensitivity 88% and specificity 90%]. Elevated CSF lactate and glutamate were recorded to be sensitive predictors of adverse outcome [sensitivity 80% and specificity 95%]. Elevated plasma lactate recorded 60% sensitivity and 70%specificity as a predictor of outcome in NBM. Cranial Doppler was also proved a sensitive outcome predictor especially decreased regional cerebral blood flow [sensitivity 72% and specificity 90%] and increased pulsatility indices [sensitivity 80% and specificity 95%]
Conclusion: increased CSF levels of lactate and glutamate as well as presence of high pulsatility index by cranial ultrasonography provided the most useful information as early outcome predictors in NBM. EEG background activity and presence of seizures more than 12 hours came in the second degree in predicting adverse outcome. Interpretation of these sensitive clinical, laboratories, electroencephalographic and ultra-sonographic parameters may help in early prediction of the adverse neurodevelopmental outcome in NBM and may be of benefit in the rapid intervention and management of these cases especially in high-risk groups