Clinical characteristics, laboratory findings, and etiological of neonatal bacterial meningitis at a tertiary children's hospital in Vietnam

Abstract

Neonatal bacterial meningitis (NBM) is a significant disease associated with substantial mortality worldwide, prolonged hospitalisation, and increased sequelae. This study aims to investigate clinical, paraclinical and etiological characteristics of neonatal bacterial meningitis at the Neonatal Intensive Care Department, Neonatal Care Centre, Vietnam National Children’s Hospital. A total of 123 newborns patients (68 boys and 55 girls) <28-days old diagnosed with NBM were admitted from May 2021 to October 2023. Clinical manifestations are various and nonspecific. Lethargy, hypotonia, respiratory distress requiring mechanical ventilation, hypotension, abdominal distension, and dirty gastric fluid were more prevalent in preterm neonates, while irritability/stimulation, hypertonia, feeding difficulties were predominant in term neonates. Statistically significant differences between term and preterm infants were observed in leucocytosis, thrombocytopenia, and coagulationNeonatal bacterial meningitis (NBM) is a significant disease associated with substantial mortality worldwide, prolonged hospitalisation, and increased sequelae. This study aims to investigate clinical, paraclinical and etiological characteristics of neonatal bacterial meningitis at the Neonatal Intensive Care Department, Neonatal Care Centre, Vietnam National Children’s Hospital. A total of 123 newborns patients (68 boys and 55 girls) <28-days old diagnosed with NBM were admitted from May 2021 to October 2023. Clinical manifestations are various and nonspecific. Lethargy, hypotonia, respiratory distress requiring mechanical ventilation, hypotension, abdominal distension, and dirty gastric fluid were more prevalent in preterm neonates, while irritability/stimulation, hypertonia, feeding difficulties were predominant in term neonates. Statistically significant differences between term and preterm infants were observed in leucocytosis, thrombocytopenia, and coagulation disorders. Positive blood cultures, cerebrospinal fluid cultures, and cerebrospinal fluid polymerase chain reaction (PCR) account for 82.5, 19.5, and 40%, respectively. The most common aetiologies in the preterm infant were Klebsiella pneumoniae, Serratia marcescens, and Escherichia coli. The term infant group included Group B Streptococcus (GBS), Escherichia coli, and Elizabethkingia meningoseptica. GBS and Escherichia coli mainly cause earlyonset neonatal bacterial meningitis (ENBM). In contrast, late-onset neonatal bacterial meningitis (LNBM) had more Klebsiella pneumoniae and Serratia marcescens. The highest mortality rate in the study was associated with Klebsiella pneumoniae and Staphylococcus aureus. In conclusion, the clinical features of NBM are diverse and nonspecific. Diagnosis tests included a complete blood count test, C-reactive protein (CRP), cerebrospinal fluid (CSF) analysis, blood and CSF culture. The common bacterial aetiology found in the study was GBS, K. pneumoniae and E. coli.