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[Bacterial meningitis in newborn infants. A retrospective study from a pediatric clinic 1967-1978]
Insights
Neonatal bacterial meningitis has a high mortality rate (59%) in newborns, with Group B Streptococcus, E. coli, and Listeria monocytogenes as common causes. Improved perinatal care and antibiotic strategies are crucial for prevention and treatment.
Area of Science:
- Neonatal infectious diseases
- Pediatric neurology
- Bacteriology
Context:
- Bacterial meningitis is a severe infection in newborns.
- This study reviewed 22 cases over 11 years at a single center.
- High mortality rates are characteristic of neonatal meningitis.
Purpose:
- To analyze the epidemiology, treatment, and outcomes of bacterial meningitis in neonates.
- To identify common causative agents and risk factors.
- To evaluate treatment strategies, including intrathecal antibiotics.
Summary:
- Group B Streptococcus, Escherichia coli, and Listeria monocytogenes were the most frequent pathogens.
- The overall mortality rate was 59%, with survivors showing mostly favorable neurological outcomes.
- Risk factors include low birth weight, premature membrane rupture, and maternal infection.
- Intrathecal antibiotic administration showed poor results and is not recommended.
- Chloramphenicol's better blood-brain barrier penetration warrants further investigation.
Impact:
- Highlights the need for enhanced perinatal care to prevent neonatal meningitis.
- Suggests re-evaluating antibiotic choices for improved treatment efficacy.
- Informs clinical practice regarding the management of this critical condition.
Abstract:
A total of 22 newborn infants (14 boys, 8 girls) have been admitted and treated for bacterial meningitis in the University Pediatric Service of Geneva over a period of 11 years (May 1967 to May 1978). The three most common infectious agents were: Group B beta-hemolytic Streptococcus (6/22 cases), Escherichia coli (6/22 cases), and Listeria monocytogenes (4/22 cases). Thirteen of the 22 infants died (a 59% mortality, in keeping with that observed in other centers). Follow-up of the nine survivors showed a relatively favorable course from a developmental and neurological point of view. Only two of the infants have significant sequelae. Factors predisposing toward the occurrence of neonatal meningitis are a small birth weight, premature rupture of the membranes, and perinatal maternal infection. Prevention of neonatal meningitis is therefore very much dependent upon good perinatal care of the mother. Treatment of neonatal meningitis is impaired by the poor diffusion of antibiotics through the blood-brain barrier. Intrathecal antibiotics were used in 4 cases in this series, and three of these 4 patients died: intrathecal antibiotherapy is obviously not a good solution. Molecules with a better diffusion such as chloramphenicol should be considered with renewed interest.