Early onset neonatal meningitis in Australia and New Zealand, 1992–2002
- M May1,2,
- A J Daley3,
- S Donath4,
- D Isaacs2,
- on behalf of the Australasian Study Group for Neonatal Infections
- 1Department of Microbiology, The Children’s Hospital at Westmead, Westmead, NSW 2145, Australia
- 2Department of Immunology and Infectious Diseases, The Children’s Hospital at Westmead
- 3Department of Microbiology and Infectious Diseases, The Royal Children’s Hospital, Parkville, Victoria 3052, Australia
- 4Murdoch Children’s Research Institute and University of Melbourne Department of Paediatrics, Parkville, Victoria 3052, Australia
- Correspondence to:
Department of Immunology and Infectious Diseases, The Children’s Hospital at Westmead, Locked Bag 4001, Westmead, NSW 2145, Australia;
- Accepted 8 February 2005
- Published Online First 5 May 2005
Objectives: To study the epidemiology of early onset neonatal bacterial meningitis (EONBM) in Australasia.
Design: Prospective surveillance study, 1992–2002, in 20 neonatal units in Australia and New Zealand. EONBM was defined as meningitis occurring within 48 hours of delivery.
Results: There were 852 babies with early onset sepsis, of whom 78 (9.2%) had EONBM. The incidence of early onset group B streptococcal meningitis fell significantly from a peak of 0.24/1000 live births in 1993 to 0.03/1000 in 2002 (p trend = 0.002). There was no significant change over time in the incidence of Escherichia coli meningitis. The rate of EONBM in very low birthweight babies was 1.09/1000 compared with the rate in all infants of 0.11/1000. The overall rate of EONBM was 0.41/1000 in 1992 and 0.06 in 2001, but this trend was not significant (p trend = 0.07). Case-fatality rates for EONBM did not change significantly with time. Birth weight <1500 g (odds ratio (OR) 7.2 (95% confidence interval (CI) 4.8 to 10.9)) and Gram negative bacillary meningitis (OR 3.3 (95% CI 2.2 to 4.9)) were significant risk factors for mortality. Sixty two percent of the 129 babies who died from early onset sepsis or suspected sepsis did not have a lumbar puncture performed.
Conclusion: The incidence of early onset group B streptococcal meningitis has fallen, probably because of maternal intrapartum antibiotic prophylaxis, without a corresponding change in E coli meningitis. Gram negative bacillary meningitis still carries a worse prognosis than meningitis with a Gram positive organism.
- ASGNI, Australasian Study Group for Neonatal Infections
- CI, confidence interval
- CSF, cerebrospinal fluid
- EONBM, early onset neonatal bacterial meningitis
- GBS, group B streptococcus
- VLBW, very low birth weight
Published Online First 5 May 2005
Australasian Study Group for Neonatal Infections consists of: C Barfield MB FRACP (Monash Medical Centre, Melbourne, Australia); D Bouchier MB FRACP (Waikato, New Zealand); G Bury MB FRACP (Hobart Hospital, Tasmania, Australia); I Bucens MB FRACP, A Ruben MB FRACP (Royal Darwin Hospital, Darwin, Australia); D Cartwright, MB FRACP (Royal Women’s Hospital, Brisbane, Australia);,T Clothier MBBS, J Ehrlich MB FRACP, F Morey PhD (Alice Springs Hospital, Alice Springs, Australia); B Darlow MB FRACP (Christchurch, New Zealand); S Fraser MB FRACP (Mercy Hospital, Melbourne, Australia); L Gilbert MD FRACP FRCPA (Westmead Hospital, Sydney, Australia); K Grimwood MD FRACP (Wellington, New Zealand); A Daley MB FRACP FRCPA, P McDougall MD FRACP, J Royle MB FRACP (The Royal Children’s Hospital, Melbourne, Australia); D Henderson-Smart MD FRACP, H Jeffery MD FRACP (King George V Hospital, Sydney, Australia); D Isaacs MD FRACP (The Children’s Hospital at Westmead, Sydney, Australia); R Kohan MB FRACP (King Edward Memorial Hospital, Perth, Australia); A McPhee MB FRACP (Women’s and Children’s Hospital, Adelaide, Australia); R Messer MB FRACP (Cairns Base Hospital, Cairns, Australia); C Minutillo MD FRACP (Princess Margaret Hospital, Perth, Australia); D Tudehope MD FRACP (Mater Hospital, Brisbane, Australia); J Whitehall MB FRACP (Kirwan Hospital, Townsville, Australia).
Competing interests: none declared