To identify the risk factors for the sequela and death in neonates with purulent meningitis.

Forty-three neonates with purulent meningitis were selected at Affiliated Hospital of yangzhou University from January 1, 2005 to December 1, 2015. Based on the prognostic status, the patients were divided into a good prognosis group (n=17) and a poor prognosis group (n=26). Clinical information such as routine cerebrospinal fluid (CSF) tests, biochemistry tests, bacterial culture, CRP, CBC, blood culture, skull CT or MRI data was collected from medical records. Clinical manifestation, pathogen composition of neonatal purulent meningitis, CSF culture, and clinical outcome were summarized. Logistic analysis and Wald test were used to identify the risk factors for the sequela and death in neonates with purulent meningitis.

Neonatal purulent meningitis had atypical clinical manifestations and often manifested as nonspecific infection. CSF culture was positive in eight (18.60%) cases, including three (37.50%) cases of Klebsiella pneumoniae infection, two (25.00%) cases of Staphylococcus aureus infection, one (12.50%) case of Enterobacter aerogenes infection, one (12.50%) case of Escherichia coli infection, and one (12.50%) case of Enterobacter sakazakii infection. Six patients died, with a mortality rate of 13.95%. Other adverse outcomes included moderate-to-severe intracranial hemorrhage in seven (16.28%) cases, dyskinesia in four (9.30%), white matter lesions in four (9.30%), hydrocephalus in three (6.98%), cerebral necrosis in two (4.65%), cerebral softening in two (4.65%), epilepsy in two (4.65%), and dyskinesia in two (4.65%). The logistic analysis showed that the risk factors for the poor prognosis were cerebrospinal fluid protein concentration>3000 mg/L (OR=5.30, 95%CI=1.51-172.99, P=0.01), peripheral white blood cells<5.0×10⁹/L (OR=5.02, 95%CI=1.43-224.89, P=0.03) and positive CSF culture (OR=4.02, 95%CI= 1.08-787.44, P=0.03).

The mortality and sequela rates of neonatal purulent meningitis are high. CSF protein concentration > 3000 mg/L, peripheral white blood cells < 5.0×10⁹/L, and positive CSF culture are risk factors for poor prognosis of neonatal purulent meningitis.