Neurological Complications in Neonatal and Infant Bacterial Meningitis: A Systematic Review and Meta-Analysis

Background

Bacterial meningitis in neonates and infants is associated with high morbidity and mortality. Theincidence of bacterial meningitis has decreased in developed countries due to the use of conjugatesvaccines but the incidence is still high in developing countries. Neurological complications afterbacterial meningitis in neonates and infants can cause long-term sequelae such as neurodevelopmentaldelay and motor and psychometric impairment. The aim of this study is to investigate the prevalence ofneurological complications in neonates and infants diagnosed with bacterial meningitis.

Methods

Systematic electronic searches were conducted in EMBASE, MEDINE, and Google Scholar from January2000 to December 2020 to identify relevant studies. The quality of studies was assessed using theNewcastle-Ottawa-Scale. The random-effect model was used to calculate the pooled prevalence.

Results

A total of 10 studies involving 1206 patients were included in this systematic review. Five studies wereconducted in developing countries while five studies were conducted in developed countries. Theoverall prevalence of neurological complications in neonates and infants was 39.0% (95% CI 0.28-0.51).The most common neurological complication was hydrocephalus (11.5%, n=139) followed by seizure(9.5%, n=114), intracranial haemorrhage (9.1%, n=110), subdural effusion (6.8%, n=82), ventriculitis(4.6%, n=55), brain abscesses (4.2%, n=51), and brain infarct (3.1%, n=37). The common organismsfrom cerebrospinal fluid culture or blood culture were Group B Streptococcus (n=260), Escherichia coli(n=124), coagulase-negative Staphylococcus (n=78), Haemophilus influenzae (n=16), Neisseriameningitidis (n=11), and Listeria monocytogenes (n=10).

Conclusions

Neurological complications are frequently developed in neonates and infants diagnosed with bacterialmeningitis. Awareness of neurological sequelae is essential for planning clinical management toimprove patient outcomes. Frequent clinical follow-up with comprehensive neurological anddevelopmental assessment is needed after the disease to identify any complications.