Factors for poor outcomes of neonatal bacterial meningitis: a retrospective multicenter study

Neonatal bacterial meningitis remains a severe infectious disease associated with substantial mortality and long-term neurological sequelae. This study aimed to identify factors associated with poor outcomes and to determine independent prognostic predictors in neonates with bacterial meningitis.

This retrospective multicenter cohort study included neonates diagnosed with bacterial meningitis. Clinical characteristics, laboratory findings, microbiological data, treatment responses, and outcomes were analyzed. Univariate and multivariable logistic regression analyses were performed to identify factors associated with poor outcomes.

A total of 85 neonates were included in the final analysis. 31 neonates (36.5%) experienced poor outcomes, including death or long-term neurological sequelae. In multivariable analysis, the presence of neurological signs at admission (odds ratio [OR]: 7.315; 95% confidence interval [CI]: 1.875-28.535) and the development of acute neurological complications during hospitalization (OR: 7.541; 95% CI: 2.045-27.807) were the only factors independently associated with poor outcomes. Several variables, including elevated cerebrospinal fluid protein levels, early administration of blood-brain barrier (BBB)-permeable antibiotics prior to lumbar puncture, and adequate response to initial antimicrobial therapy, were significantly associated with outcomes in univariate analyses but did not retain statistical significance after multivariable adjustment.

Neurological involvement at presentation and acute neurological complications are key independent predictors of poor outcomes in neonatal bacterial meningitis. Other clinical and laboratory variables may reflect disease severity or early clinical course and may assist in early risk stratification.