Risk Factors and Clinical Parameters Associated with the Severity of the Clinical Picture of Enteroviral Meningitis in Neonates Treated in the Tertiary Neonatal Unit in Slovenia

Abstract

Objective – To describe the clinical course of enteroviral meningitis in neonates in a tertiary neonatal unit.

Materials and Methods – We analysed maternal and perinatal history, clinical and laboratory data, therapy and short-term outcomes in neonates who had enterovirus detected in the cerebrospinal fluid (CSF) and compared the group of neonates with early-onset (≤7 day of life (DOL)) meningitis to the group of neonates with late-onset (>7 DOL) meningitis.

Results – A total of 30 term neonates were included (63% male). Majority (73%) presented during the summer and autumn months, 57% were in contact with siblings who had signs of viral disease, 10% of mothers had signs of viral disease at delivery or shortly after. Neonates presented with irritability (97%), fever (83%), feeding intolerance (66%), diarrhoea (56%), nonspecific rash (23%), seizures (10%). Both the C-reactive protein (CRP) and pro-calcitonin (PCT) were elevated in 23% of patients; only CRP was elevated in 57%, only PCT in 37%. Twelve (40%) had elevated leukocyte count in the CSF. Antibiotics were initiated in 80% (median treatment 1.5 days). Majority of the neonates with early-onset meningitis had jaundice, higher urea and creatinine serum concentration, and lower thrombocyte numbers.

Conclusion – Enteroviruses are an important cause of meningitis in neonates during summer and autumn months. Neonates in close contact with ill family members or carers are particularly at risk. Neonates present with fever, irritability, feeding intolerance, diarrhoea, normal or mildly elevated CRP and/or PCT values. Neonates with early-onset meningitis had a similar grade of infection and outcome as did the neonates with late-onset disease. Our findings confirm that enteroviral meningitis car- ries a good prognosis in the majority of neonates.