Clinical features, risk factors and outcomes of hydrocephalus in neonatal bacterial meningitis: a retrospective...

Hydrocephalus is a potentially life-threatening complication of neonatal bacterial meningitis (BM), with a poor prognosis. A retrospective case-control study was conducted among 227 newborns with BM, with and without hydrocephalus, from three centers between 2018 and 2024 to compare their demographic and clinical characteristics, explore outcomes, and analyze risk factors for hydrocephalus. Escherichia coli (36.5%) and Group B streptococcus (30.2%) were the most common pathogens. Multivariate analysis identified ventriculitis, seizures at onset, C-reactive protein > 100 mg/L, and abnormal cerebrospinal fluid (CSF) results on the second lumbar puncture (LP, within 7 days after the first), including protein > 4 g/L, glucose < 1.1 mmol/L, and WBC > 500 × 10⁶/L as risk factors for hydrocephalus. The receiver operating characteristic results showed CSF WBC, CSF glucose, and protein levels on the second LP had predictive value for hydrocephalus. Neonates with hydrocephalus in BM had significantly higher ratios of hearing impairment (53.4%), encephalomalacia (39.7%), secondary epilepsy (37.0%), and death (8.2%) in the first two years of life (all P < 0.05). Together, these data demonstrated that high WBC and CSF protein levels on the second LP were predictors of hydrocephalus in neonatal BM. Hydrocephalus in BM was significantly associated with mortality and poor outcomes.