Neonatal gram negative meningitis: a 10-year review, with reference to outcome and relapse of infection

Twenty-four infants treated for neonatal Gram negative bacillary meningitis over a 10-year period were reviewed to determine the mortality and incidence of complications including relapse. Nine (37.5%) infants died; two survivors had major and 13 minimal or no handicap. Five (21%) infants had a relapse of meningitis after the initial course of treatment; two of these infants had been treated with cefotaxime. The outcome did not correlate with age, sex, gestation, cerebrospinal fluid (CSF) parameters or peripheral neutrophil counts. A poor outcome was associated with thrombocytopenia, persistence of viable organisms in the CSF for more than 24 h and with seizures, particularly in infants aged 7 days or less. There were no clinical or laboratory parameters predictive of subsequent relapse and there was no apparent relationship with choice or dose of antibiotic used or duration of treatment.