Frequency of Coexisting Meningitis in Neonates Admitted with Late-Onset Sepsis in Nursery, MTI DHQ Hospital, Dera Ismail Khan
Meningitis in Neonates
DOI:
https://doi.org/10.54393/pjhs.v6i4.2978Keywords:
Neonatal Late-Onset Sepsis, Co-Existing Meningitis, Lethargy, Cerebrospinal Fluid Analysis, Lumbar PunctureAbstract
Neonatal Late-Onset Sepsis (LOS) is a serious condition that can lead to co-existing meningitis, increasing the risk of long-term complications and mortality. Early diagnosis remains challenging due to non-specific clinical symptoms and limitations in performing Lumbar Punctures (LPs). Objective: To determine the frequency of co-existing meningitis in neonates with LOS and identify clinical and laboratory markers associated with it. Methods: Neonates aged ≥72 hours with signs of LOS were included. Demographic data, clinical symptoms, and laboratory parameters were recorded. A comparative cross-sectional study was conducted in the neonatal nursery of DHQ Hospital, MTI, Dera Ismail Khan. Blood samples were analyzed for C - Reactive Protein (CRP), White Blood Cell (WBC) count, and blood culture, while CSF analysis included WBC count, protein, glucose, and culture. Data were analyzed using SPSS version 25.0, with the Chi-square test used for categorical variables and independent t-tests for continuous variables. A p-value of <0.05 was considered statistically significant. Results: Among 95 neonates with LOS, 53.7% had meningitis. Lethargy (p = 0.024) and previous antibiotic use (p = 0.034) were significantly associated with meningitis, while other clinical signs showed no significant difference. CSF analysis revealed elevated WBC counts in meningitis cases, but CRP and blood WBC were not significantly different. Conclusions: Meningitis was frequent among neonates with LOS, with lethargy and prior antibiotic use as key risk factors. Early identification of these factors may aid in timely diagnosis and intervention. Further multi-center studies are recommended to validate these findings.
References
Li J, Shen L, Qian K. Global, regional, and national incidence and mortality of neonatal sepsis and other neonatal infections, 1990-2019. Frontiers in Public Health. 2023 Mar; 11: 1139832. doi: 10.3389/fpubh.2023.1139832.
Wright C, Blake N, Glennie L, Smith V, Bender R, Kyu H et al. The global burden of meningitis in children: challenges with interpreting global health estimates. Microorganisms. 2021 Feb; 9(2): 377. doi: 10.3390/microorganisms9020377.
Zinjani S. Common Medical Conditions in the Neonates. InClinical Anesthesia for the Newborn and the Neonate 2023 Jan: 49-70. doi: 10.1007/978-981-19-5458-0_4.
Bedetti L, Miselli F, Minotti C, Latorre G, Loprieno S, Foglianese A et al. Lumbar puncture and meningitis in infants with proven early-or late-onset sepsis: an Italian prospective multicenter observational study. Microorganisms. 2023 Jun; 11(6): 1546. doi: 10.3390/microorganisms11061546.
Joseph S, Ravi A, Pillai K. Epidemiology of Lumbar Puncture and the Validity of Meningeal Signs in Predicting Meningitis in Children: A Cross-sectional Study. Journal of Clinical & Diagnostic Research. 2025 Jan; 19(1). doi: 10.7860/JCDR/2025/74520.20512.
Bajaj, M., et al. A study of clinico-bacteriological profile and to determine incidence of meningitis in late onset sepsis in newborn unit of tertiary care teaching hospital in Northern India. International Journal of Contemporary Pediatrics, 2022; 9(7): 647. doi: 10.18203/2349-3291.ijcp20221607.
Coggins SA and Glaser K. Updates in late-onset sepsis: risk assessment, therapy, and outcomes. Neoreviews. 2022 Nov; 23(11): 738-55. doi: 10.1542/neo.23-10-e738.
Nafis, S., et al. Frequency of Meningitis in Neonates with Late Onset Sepsis: A Cross Sectional Study. Khyber Journal of Medical Sciences. 2024 Jul-Sep; 17(3): 161. doi: 10.70520/kjms.v17i3.537.
Naveed S, Fayyaz M, Siddiqa S, Samaa A, Rahman R, Sial Z. Meningitis In Newborns With Late-Onset Sepsis; A Critical Insight. Journal of Rawalpindi Medical College. 2024 Sep; 28(3). doi: 10.37939/jrmc.v28i3.2377.
Behera JR, Mallick MR, Meher AK, Brahma A. Study of Clinical Spectrum and Immediate Outcome of Neonatal Bacterial Meningitis in A Tertiary Care Hospital. European Journal of Cardiovascular Medicine. 2023 Oct; 13(4). doi: 10.5083/ejcm/2023-11-54.
Wondimu MN, Toni AT, Zamanuel TG. Magnitude of neonatal meningitis and associated factors among newborns with neonatal sepsis admitted to the University of Gondar Comprehensive Specialized Hospital, North Gondar, Ethiopia. PLOS One. 2023 Sep; 18(9): e0290639. doi: 10.1371/journal.pone.0290639.
Al Bakoush, F.B., A.E. Azab, and R. Yahya, Neonatal sepsis: insight into incidence, classification, risk factors, causative organisms, pathophysiology, prognosis, clinical manifestations, complications, systemic examination, and treatment. South Asian Research Journal of Medical Sciences. 2023; 5(6): 136-57. doi: 10.36346/sarjams.2023.v05i06.004.
Niemelä, S., Bacterial Meningitis-Incidence, Etiology, Predisposing Factors and Outcome. ISBN 978-951-29-9848-7. 2024 Sep.
Pace E and Yanowitz T. Infections in the NICU: Neonatal sepsis. InSeminars in pediatric surgery 2022 Aug; 31(4): 151200. doi: 10.1016/j.sempedsurg.2022.151200.
Orfanos I. Prevalence of serious bacterial infections and management of febrile infants≤ 60 days in Swedish Pediatric Emergency Departments. Lund University; 2023.
Boscarino G, Romano R, Iotti C, Tegoni F, Perrone S, Esposito S. An overview of antibiotic therapy for early-and late-onset neonatal sepsis: Current strategies and future prospects. Antibiotics. 2024 Mar; 13(3): 250. doi: 10.3390/antibiotics13030250.
Bader RS, Allabadi H, Ihsoun JM, Atout H, Khreishi RH, Bzour AM et al. Identification of bacterial pathogens and antimicrobial susceptibility of early-onset sepsis (EOS) among neonates in Palestinian hospitals: a retrospective observational study. BioMed Central Pediatrics. 2025 Dec; 25(1): 1-3. doi: 10.1186/s12887-025-05470-6.
Ericson JE, Agthe AG, Weitkamp JH. Late-Onset sepsis: epidemiology, microbiology, and controversies in practice. Clinics in Perinatology. 2025 Mar; 52(1): 33-45. doi: 10.1016/j.clp.2024.10.003.
Ting JY, Autmizguine J, Dunn MS, Choudhury J, Blackburn J, Gupta-Bhatnagar S et al. Practice summary of antimicrobial therapy for commonly encountered conditions in the neonatal intensive care unit: a Canadian perspective. Frontiers in Pediatrics. 2022 Jul; 10: 894005. doi: 10.3389/fped.2022.894005.
Kartam M, Embaireeg A, Albalool S, Almesafer A, Hammoud M, Al-Hathal M et al. Late-onset sepsis in preterm neonates is associated with higher risks of cerebellar hemorrhage and lower motor scores at three years of age. Oman Medical Journal. 2022 Mar; 37(2): e368. doi: 10.5001/omj.2022.41.
Sherman G, Lamb GS, Platt CD, Wessels MR, Chochua S, Nakamura MM. Simultaneous Late, Late-Onset Group B Streptococcal Meningitis in Identical Twins. Clinical Pediatrics. 2023 Feb; 62(2): 96-9. doi: 10.1177/00099228221113630.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 Pakistan Journal of Health Sciences

This work is licensed under a Creative Commons Attribution 4.0 International License.
This is an open-access journal and all the published articles / items are distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. For comments