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Published on: January 27, 2023
Epidemiology of Meningitis in Canadian Neonatal Intensive Care Units
Walid El-Naggar1, Jehier Afifi1, Douglas McMillan1
1From the Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia, Canada.
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.
Insights
Neonatal meningitis (NM) rates in Canadian NICUs remain stable. While NM increases seizures, lung issues, and hospital stays, it does not significantly impact mortality before discharge.
Area of Science:
- Neonatal Medicine
- Infectious Diseases
- Epidemiology
Background:
- Meningitis is a significant neonatal health concern, disproportionately affecting newborns compared to other age groups.
- Current epidemiological data on neonatal meningitis (NM) is limited, necessitating updated research.
- Understanding NM trends is crucial for improving neonatal care and outcomes.
Purpose of the Study:
- To determine the incidence rates of NM in Canadian Neonatal Intensive Care Units (NICUs).
- To identify the primary causative organisms, risk factors, and temporal trends of NM.
- To assess the short-term outcomes and associated morbidities in neonates with NM.
Main Methods:
- A retrospective cohort study was conducted using data from the Canadian Neonatal Network (2010-2016).
- Infants admitted to NICUs with meningitis were identified and their data reviewed.
- Outcomes were compared between neonates with meningitis and a matched cohort without the condition.
Main Results:
- NM incidence ranged from 2.2 to 3.5 per 1000 NICU admissions; 87% were late-onset (>3 days).
- Escherichia coli and group B streptococci were the most common pathogens.
- NM correlated with increased seizures, retinopathy of prematurity, bronchopulmonary dysplasia, and longer hospital stays, but not mortality.
Conclusions:
- The incidence of NM in Canadian NICUs has remained consistent over the study period.
- Neonatal meningitis is linked to significant morbidities and extended hospitalization.
- Despite associated complications, NM did not show a significant increase in mortality before hospital discharge.
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