Predicting the outcome of neonatal bacterial meningitis.

Abstract:

OBJECTIVE:To build predictive models of severe adverse outcome at various times in the course of neonatal bacterial meningitis. STUDY DESIGN:Retrospective cohort study with follow-up to a minimum age of 1 year of term and near-term infants, admitted between 1979 and 1998 to a regional tertiary care center. Predictors of adverse outcome detectable at 1 year of age (death or moderate or severe neurosensory impairment) were identified by univariate analysis. Independent predictors of adverse outcome were identified by multivariate analysis. Predictive tree models were constructed at 12, 24, 48, and 96 hours after admission and at discharge. RESULTS:Of 101 infants admitted with definitive bacterial meningitis, 13 died and 17 had moderate or severe disability at 1 year of age. Outcomes are known for all patients, to 1 year of age. Twelve hours after admission the important predictors of adverse outcome were presence of seizures, presence of coma, use of inotropes, and leukopenia (sensitivity: 68%; specificity: 100%). At 96 hours the predictors were seizure duration of >72 hours, presence of coma, use of inotropes, and leukopenia (sensitivity: 88%; specificity: 99%). CONCLUSIONS:Most infants at risk for adverse outcome can be identified within 12 hours of admission. Duration of seizures for >72 hours, presence of coma, use of inotropes, and leukopenia were the most important predictors of adverse outcome. Although these models have good predictive accuracy, they need to be validated in a contemporary cohort in large multicenter studies.

journal_name

Pediatrics

journal_title

Pediatrics

authors

Klinger G,Chin CN,Beyene J,Perlman M

doi

10.1542/peds.106.3.477

subject

Has Abstract

pub_date

2000-09-01 00:00:00

pages

477-82

issue

3

eissn

0031-4005

issn

1098-4275

journal_volume

106

pub_type

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