Predictors of Meningitis in Early Onset Sepsis in Neonates

Abstract

Background: Meningitis is more commonly observed during the neonatal period than at any other stage of life. Diagnosing neonatal meningitis is especially difficult because its clinical features often overlap with those of sepsis. The determinants of meningitis in neonates with sepsis may vary depending on the study population and setting. Recognizing these factors is crucial for facilitating early diagnosis and prompt intervention, thereby improving both immediate and long-term patient outcomes. So, the present study was designed to find out the predictors of meningitis in early onset sepsis in neonates. Methods: A cross-sectional study was conducted at the department of neonatology, University of Child health sciences (UCHS) Children’s Hospital, Lahore, from November, 2025 to March, 2026. Demographic data, anthropometric measures, clinical signs and laboratory data were recorded on pre-designed proforma. All the data was analyzed by using Statistical Package for Social Science (SPSS) version-22. The association between various predictors and the development of meningitis were assessed using chi-square tests. Multivariate logistic regression model was also applied. A p-value of <0.05 was considered as statistically significant. Results: The mean age of study participants was 7.4 ± 2.1 days with male predominance (71.1%). The mean birth weight was 2.7 ± 0.8kg while the frequency of low birth weight was 47.9% and reported statically significant association. The frequency of maternal infection, perinatal asphyxia and meconium-stained liquor were 48.6%, 52.8% and 41.5% respectively with strong significant association (p-value≤0.05). Majority of study participants (27.5%) were clinically presented with the complaint of lethargy and poor feeding. The complete blood cell counts reported leukopenia in 34.5% study participants and leukocytosis in 33.8% participants. The mean value of C-reactive protein (CRP) was 37.5 ± 9.4mg/dL. Blood culture was positive in 61.2% neonates while cerebrospinal fluid (CSF) culture was positive among 45.8% neonates. Conclusion: Findings of current study indicate that the maternal infection, perinatal asphyxia, meconium-stained liquor, prematurity and low birth weight were the most common predictors of meningitis in early onset sepsis in neonates. Furthermore, leukocytosis, leukopenia, positive blood culture and positive CSF culture could also be the strong predictors of meningitis.