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Early onset neonatal meningitis in Australia and New Zealand, 1992–2002
  1. M May1,2,
  2. A J Daley3,
  3. S Donath4,
  4. D Isaacs2,
  5. on behalf of the Australasian Study Group for Neonatal Infections
  1. 1Department of Microbiology, The Children’s Hospital at Westmead, Westmead, NSW 2145, Australia
  2. 2Department of Immunology and Infectious Diseases, The Children’s Hospital at Westmead
  3. 3Department of Microbiology and Infectious Diseases, The Royal Children’s Hospital, Parkville, Victoria 3052, Australia
  4. 4Murdoch Children’s Research Institute and University of Melbourne Department of Paediatrics, Parkville, Victoria 3052, Australia
  1. Correspondence to:
    Professor Isaacs
    Department of Immunology and Infectious Diseases, The Children’s Hospital at Westmead, Locked Bag 4001, Westmead, NSW 2145, Australia; davidichw.edu.au

Abstract

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
  • meningitis
  • group B streptococcus
  • Escherichia coli
  • intrapartum antibiotics

https://doi.org/10.1136/adc.2004.066134

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    Footnotes

    • 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