Meningitis in Home Delivered Neonates in Pondicherry, South India

In developed countries about 20-30 per cent of neonates with septicaemia suffer meningeal complications. However little data are available from developing countries particularly in home-delivered neonates. We studied neonates delivered at home and subsequently admitted with septicaemia for evidence of meningitis. From January 1994 to July 1995 65 neonates including 11 preterm infants who were admitted with a diagnosis of septicaemia were studied prospectively. Based on CSF neutrophil pleocytosis or positive CSF bacterial isolate 17 (38 per cent) had evidence of meningitis of which six were preterm. At an early stage there was no conclusive evidence from symptoms and signs to indicate associated meningitis although fever apnoea and respiratory distress were useful predictors of meningitis. The onset of illness was early <3 days of life in two and late <14-28 days in 10. The mortality was significantly higher in the early onset group. It was not surprising that mortality among neonates with evidence of meningitis was significantly higher than among septic newborns without meningitis 47 per cent against 10 per cent. (excerpt)