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Multicenter Study
. 2021 May;8(5):1132-1140.
doi: 10.1002/acn3.51356. Epub 2021 Apr 9.

A sequential guide to identify neonates with low bacterial meningitis risk: a multicenter study

Yan Chen  1 , Zhanghua Yin  1 , Xiaohui Gong  2 , Jing Li  3 , Wenhua Zhong  4 , Liqin Shan  4 , Xiaoping Lei  5 , Qian Zhang  6 , Qin Zhou  7 , Youyan Zhao  8 , Chao Chen  9 , Yongjun Zhang  1
Affiliations
Multicenter Study

A sequential guide to identify neonates with low bacterial meningitis risk: a multicenter study

Yan Chen et al. Ann Clin Transl Neurol. 2021 May.

Abstract

Objective: To derive and validate a predictive algorithm integrating clinical and laboratory parameters to stratify a full-term neonate's risk level of having bacterial meningitis (BM).

Methods: A multicentered dataset was categorized into derivation (689 full-term neonates aged ≤28 days with a lumbar puncture [LP]) and external validation (383 neonates) datasets. A sequential algorithm with risk stratification for neonatal BM was constructed.

Results: In the derivation dataset, 102 neonates had BM (14.8%). Using stepwise regression analysis, fever, infection source absence, neurological manifestation, C-reactive protein (CRP), and procalcitonin were selected as optimal predictive sets for neonatal BM and introduced to a sequential algorithm. Based on the algorithm, 96.1% of BM cases (98 of 102) were identified, and 50.7% of the neonates (349 of 689) were classified as low risk. The algorithm's sensitivity and negative predictive value (NPV) in identifying neonates at low risk of BM were 96.2% (95% CI 91.7%-98.9%) and 98.9% (95% CI 97.6%-99.6%), respectively. In the validation dataset, sensitivity and NPV were 95.9% (95% CI 91.0%-100%) and 98.8% (95% CI 97.7%-100%).

Interpretation: The sequential algorithm can risk stratify neonates for BM with excellent predictive performance and prove helpful to clinicians in LP-related decision-making.

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Conflict of interest statement

The authors have no conflict of interest to declare.

Figures

Figure 1
Figure 1
Study subjects’ flow chart.
Figure 2
Figure 2
Prevalence of neonatal bacterial meningitis in different risk subgroups in the derivation set (0–28 days). –LR, Negative likelihood ratio; NPV, Negative predictive value. Neurological manifestation: Including seizure, abnormal muscle tone, irritability, bulging anterior fontanelle, etc. Fever with definite source of infection or without fever? No*: With fever but absence of infection source; Yes*: With fever and definite source of infection, or without fever.
Figure 3
Figure 3
Prevalence of neonatal bacterial meningitis in different risk subgroups in the validation set (0–28 days). NPV: Negative predictive value; −LR: Negative likelihood ratio. Fever with definite source of infection or without fever? No*: With fever but absence of infection source; Yes*: With fever and definite source of infection, or without fever.
Figure 4
Figure 4
Web tool calculator.
See this image and copyright information in PMC

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