Clinical Features, Outcomes, Predictive Factors and Prognosis of Hydrocephalus in Neonatal Bacterial Meningitis: A Prospective Case-Control Study

Hydrocephalus is one of the most common complications of bacterial meningitis (BM). A retrospective case-control study were conducted to evaluate the etiologies, predictive factors and adverse outcomes of hydrocephalus in BM. A total of 227 neonates who met the inclusion criteria were enrolled in the study cohort, of which 73 neonates with hydrocephalus. Escherichia coli and Group B streptococcus were the most common causative pathogens causing hydrocephalus. The factors that were significantly associated with hydrocephalus in multivariate analysis were: encephalopyosis, second CSF glucose < 1.1 mmol/L, second CSF protein > 4 g/L, C-reactive protein (CRP) > 100 mg/L, third CSF WBC > 100×10^6/L, convulsion at onset, and initial CSF WBC > 5000×10^6/L. The receiver operating characteristic results also showed CSF WBC, CSF glucose, and protein level on the second LP also had predictive value for hydrocephalus. Neonates with hydrocephalus in BM had significantly higher ratio of secondary epilepsy, hearing impairment, encephalomalacia, and death in the two year of life (all P  < 0.05). Together these data demonstrated that a severe clinical manifestation and significant CSF parameters at admission are the most important predictors of hydrocephalus in neonatal BM. Hydrocephalus in BM was significantly associated with mortality and poor outcome.