Background:

Neonatal bacterial meningitis has high rates of morbidity and mortality. Early clinical signs and neuroimaging suggest adverse outcomes, but little is known about their combined predictive properties. We evaluated the combination of findings most associated with death and neurodevelopmental impairment.

Methods:

Single-center retrospective cohort study of term and late preterm neonates with bacterial meningitis. Predictors of death and neurodevelopmental impairment were identified on univariate analysis and incorporated into Lasso models to identify variables best predicting adverse outcomes.

Results:

Of 103 neonates, 6 died acutely; 30% of survivors had neurodevelopmental impairment. Clinical variables (seizures, pressor support) predicted death and neurodevelopmental impairment better than the neuroimaging or combined findings (area under the curve 0.88 vs 0.79 and 0.83, respectively). Among survivors, neuroimaging findings (cerebrovascular lesions, ventriculomegaly) predicted neurodevelopmental impairment better than clinical or combined findings (area under the curve 0.82 vs 0.80 and 0.77, respectively).

Conclusions:

Seizures are important predictors of adverse outcomes in neonatal bacterial meningitis. Among survivors, neuroimaging findings help predict neurodevelopmental impairment.

中文翻译：

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新生儿细菌性脑膜炎后神经发育障碍的预测因素

背景：

新生儿细菌性脑膜炎的发病率和死亡率都很高。早期临床症状和神经影像学提示不良后果，但对其综合预测特性知之甚少。我们评估了与死亡和神经发育障碍最相关的发现组合。

方法：

足月和晚期早产儿细菌性脑膜炎的单中心回顾性队列研究。在单变量分析中确定了死亡和神经发育障碍的预测因子，并将其纳入 Lasso 模型，以确定最能预测不良结果的变量。

结果：

在 103 名新生儿中，有 6 名急性死亡；30% 的幸存者有神经发育障碍。临床变量（癫痫发作、升压支持）比神经影像学或综合结果（曲线下面积分别为 0.88 对 0.79 和 0.83）更能预测死亡和神经发育障碍。在幸存者中，神经影像学检查结果（脑血管病变、脑室扩大）比临床或综合检查结果（曲线下面积分别为 0.82 和 0.80 和 0.77）更能预测神经发育障碍。

结论：

癫痫发作是新生儿细菌性脑膜炎不良结局的重要预测因素。在幸存者中，神经影像学发现有助于预测神经发育障碍。