Neurological complications after neonatal bacteremia: the clinical characteristics, risk factors, and outcomes

Abstract

Background: Neonates with bacteremia are at risk of neurologic complications. Relevant information warrants further elucidation.

Study design: This was a retrospective cohort study of neonates with bacteremia-related neurologic complications (BNCs) in a tertiary-level neonatal intensive care unit (NICU). A systemic chart review was performed conducted to identify clinical characteristics and outcomes. A cohort of related conditions was constructed as the control group. Logistic regression analysis was used to identify independent risk factors for BNC.

Results: Of 1037 bacteremia episodes, 36 (3.5%) had BNCs. Twenty-four cases of BNCs were related to meningitis, five were presumed meningitis, and seven occurred after septic shock. The most common causative pathogens were Group B streptococcus (41.7%) and E. coli (16.7%). The major BNCs consisted of seizures (28), hydrocephalus (20), encephalomalacia (11), cerebral infarction (7), subdural empyema (6), ventriculitis (8), and abscess (4). Eight (22.8%) neonates died and six (16.7%) were discharged in critical condition when the family withdrew life-sustaining treatment. Among the 22 survivors, eight had neurologic sequelae upon discharge. After multivariate logistic regression analysis, neonates with meningitis caused by Group B streptococcus (adjusted odds ratio [OR]: 8.90, 95% confidence interval [CI]: 2.20-36.08; p = 0.002) and combined meningitis and septic shock (OR, 5.94; 95% CI: 1.53-23.15; p = 0.010) were independently associated with BNCs.

Conclusions: Neonates with bacteremia-related neurologic complications are associated with adverse outcomes or sequelae. Better strategies aimed at early detection and reducing the emergence of neurologic complications and aggressive treatment of Group B streptococcus sepsis are needed in neonates with meningitis and septic shock.

Figure 1. Time to diagnosis of various bacteremia-related neurological complications in the neonatal intensive care unit.

Bacteremia onset was defined as when the blood culture sampling was obtained, whereas onset of neurological complication was defined at the symptom presentation or diagnosis by neuroimaging studies.

Figure 2. The Kaplan-Meier survival curve of neonates with bacteremia-related neurological complications (BNCs), and those discharged in a critical condition after withdrawing life-sustaining treatments were considered dead at the day of discharge.