NEONATAL BACTERIAL MENINGITIS AT THE NEWBORN UNIT OF KENYATTA NATIONAL HOSPITAL

Abstract

ABSTRACT
Background: Meningitis occurs in up to one third of neonates with septicaemia. Diagnosis
is difficult due to its non-specificity of signs and symptoms. While neonatal septicaemia
is a common problem at Kenyatta National Hospital (KNH), there are no recent data
on the incidence and clinical characteristics of neonatal meningitis at the hospital.
Objective: To evaluate the prevalence and the bacterial aetiology of meningitis in neonates
at the Newborn Unit (NBU) of KNH.
Design: Descriptive cross-sectional study.
Setting: Newborn Unit of Kenyatta National Hospital, Nairobi, Kenya.
Subjects and methods: Lumbar punctures were performed on eighty-four neonates with
suspected sepsis based on specified clinical criteria. Cases were defined as meningitis
if the cerebrospinal fluid (CSF) was positive for bacteria by Gram stain, aerobic bacterial
culture or latex particle agglutination assay.
Results: The prevalence of meningitis amongst cases of suspected sepsis was 17.9%. The
male:female ratio was l.5:1 mean birth weight 2116.7 grams (1682.2-2551.2) mean
gestational age 35.7 weeks (32.6-38.8) and the mean postnatal age was 4.1 days (2.7-
5.4) with none of the parameters being significantly different from those without
meningitis. Feed intolerance and lethargy were the most common clinical features,
present in 73.3% and 60% of patients with meningitis respectively. Neonates with
meningitis had a higher mean CSF protein value (2.67 g/L vs 1.97 g/L, p=0.367) and
a significantly higher mean CSF white cell count (21 cells/mL vs 7 cells/mL, p=0.001).
The most common aetiological agents were Escherichia coli (46.7%). Group B.
Streptococci (26.7%) and Klebsiella pneumonia (13.3%). Most blood and CSF isolates
were resistant to ampicillin and gentamicin but showed good in-vitro sensitivities to
amikacin, ceturoxime and the third generation cephalosporins (ceftriaxone, ceftazidime
and cefotaxime). Blood cultures were positive in only 53.3% of neonates with meningitis.
Conclusion: Neonatal bacterial meningitis is an important clinical problem at KNH with
a prevalence of 17.9% and amongst cases of suspected sepsis. E. coli and Group B
Streptococci were the most common aetiological pathogens. Blood cultures were negative
in almost half of the patients with meningitis. Resistance to the commonly employed
first-line antibiotics (penicillin and gentamicin) is high and a chance of empirical
antibiotic use for neonates with suspected sepsis is recommended.