Incidence of meningitis in late onset sepsis

Background:  Bacterial sepsis and meningitis continue to be major causes of morbidity and mortality in newborns, particularly in premature infants. The present study was undertaken to know the incidence of meningitis in neonates with late onset sepsis. Methods:  Hospital based observational study, conducted in the post graduate department of pediatrics, government medical college, Srinagar, conducted for a period of one year. 423 patients fulfilling the inclusion criteria were included and subjected to detailed history, clinical examination followed by investigations. Results:  The annual incidence of meningitis in LOS was 16. The majority of patients (46.1%) presented in the age group of 3-7 days. The mean weight of neonates was 2.61 ± 0.606) kg. 60.3% of neonates with meningitis were of low birth weight (P 0.005). In meningitis cases 100% cases were lethargic; seizures in 92.8%, fever in 50%. Blood culture was positive in 42.6% cases of meningitis. Meningitis was seen in 60.7% of proven gram negative sepsis as against 30.7% cases of proven gram positive sepsis (P <0.005). 94.5% of the exclusively breast fed neonates with meningitis recovered  and 6.3%  expired whereas for the other feeding group the corresponding figures were 77 % and 22.4 % respectively (P <0.005). 17.6% cases of meningitis had mortality as against 4.8% in those who had sepsis but no meningitis (P <0.005). Conclusions:  Meningitis is common in late onset sepsis, associated with high mortality, with a beneficial effect from exclusive breast feeding.