Abstract 1420 Poster Session III, Monday, 5/3 (poster 39)

Meningitis, defined by positive spinal fluid culture, occurred in 64 (2%) of 3462 VLBW admissions to our NICU between 1977 and 1995. Surprisingly, spinal fluid findings were sparse. Of 35 non-bloody spinal taps (≤1000 RBC/mm3), 5 (14%) had >30 WBCs, 5 (14%) protein >150 mg %, and 5 (14%) glucose <30 mg %. Only 11(31%) had one or more of these abnormalities.

To determine neuro-development, 39/45 (87%) meningitis survivors were compared at 20 months corrected age to 2053/2521 (81%) VLBW non meningitis survivors. Meningitis survivors had a higher rate of major neurologic abnormality [C.P., hypertonia, hypotonia (39% vs 10%, p<0.001)] and Bayley MDI < 70 (39% vs 14%, p<0.001) than non-meningitis survivors. Their Bwt was lower (872 vs 1111 gm, p<0.001), G.A. lower (26 vs 29 wks, p<0.001), and neonatal morbidity higher: septicemia (92% vs 22%, p<0.001), oxygen at 36 wks (51% vs 20%, p<0.001) and grade 3-4 IVH (31% vs 12%, p<0.001). Impairment rates did not differ by etiologic organism: Coag. neg. staph 8/18, other Gram +ve 4/8, Gram -ve 5/7, Fungi 3/6 had neuro ab. and/or MDI <70.

To determine the specific effect of meningitis on outcome, we performed logistic regression with Bwt as a co-variate controlling for sex, race, maternal ed. < high school (HS), Grade 3-4 IVH, and 02 at 36 wks. (Table)

Table 1 No caption available
Full size table

Meningitis had an independent effect on major neurologic abnormality but not on MDI < 70. Thus despite minimal spinal fluid response, neonatal meningitis contributes adversely to 20 month outcome.