Risk factors for acute neurological complications in neonatal bacterial meningitis: a retrospective cohort study

This study aimed to investigate the risk factors for acute neurological complications (ANCs) in neonates with bacterial meningitis (NBM).

This retrospective study analyzed 68 neonates (aged 0-28 days) with bacterial meningitis admitted to a tertiary pediatric medical center (Children's Hospital, Zhejiang University School of Medicine, China) between November 1, 2020, and June 30, 2025. ANCs were defined as a spectrum of conditions resulting from NBM, including subdural effusion/empyema, ventriculitis, hydrocephalus, brain abscess, and encephalomalacia. The cohort comprised 48 neonates without ANCs and 20 who developed ANCs.

Compared with neonates without complications, those who developed ANCs were significantly older at symptom onset and demonstrated higher rates of seizures, elevated C-reactive protein (CRP) levels, increased cerebrospinal fluid (CSF) culture positivity, higher rates of Group B Streptococcus (GBS) infection, and more frequent dexamethasone administration. Multivariate logistic regression analysis identified seizures (OR = 10.951, 95% CI: 1.981-60.532, p = 0.006) and GBS infection (OR = 4.803, 95% CI: 1.072-21.523, p = 0.040) as independent risk factors for ANCs. Dexamethasone use (OR = 0.946, 95% CI: 0.185-4.834, p = 0.947) was not significant after adjustment. A predictive model incorporating both factors demonstrated good discriminatory capacity (AUC = 0.814, 95% CI: 0.686-0.942, p < 0.001).

Seizures and GBS infection are independent risk factors for ANCs in NBM. Dexamethasone administration did not reduce the incidence of ANCs in this cohort.