NEONATAL BACTERIAL MENINGITIS AT THE NEWBORN UNIT OF KENYATTA NATIONAL HOSPITAL

ABSTRACTBackground: Meningitis occurs in up to one third of neonates with septicaemia. Diagnosisis difficult due to its non-specificity of signs and symptoms. While neonatal septicaemiais a common problem at Kenyatta National Hospital (KNH), there are no recent dataon the incidence and clinical characteristics of neonatal meningitis at the hospital.Objective: To evaluate the prevalence and the bacterial aetiology of meningitis in neonatesat 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 withsuspected sepsis based on specified clinical criteria. Cases were defined as meningitisif the cerebrospinal fluid (CSF) was positive for bacteria by Gram stain, aerobic bacterialculture or latex particle agglutination assay.Results: The prevalence of meningitis amongst cases of suspected sepsis was 17.9%. Themale:female ratio was l.5:1 mean birth weight 2116.7 grams (1682.2-2551.2) meangestational 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 withoutmeningitis. Feed intolerance and lethargy were the most common clinical features,present in 73.3% and 60% of patients with meningitis respectively. Neonates withmeningitis had a higher mean CSF protein value (2.67 g/L vs 1.97 g/L, p=0.367) anda 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 isolateswere resistant to ampicillin and gentamicin but showed good in-vitro sensitivities toamikacin, ceturoxime and the third generation cephalosporins (ceftriaxone, ceftazidimeand cefotaxime). Blood cultures were positive in only 53.3% of neonates with meningitis.Conclusion: Neonatal bacterial meningitis is an important clinical problem at KNH witha prevalence of 17.9% and amongst cases of suspected sepsis. E. coli and Group BStreptococci were the most common aetiological pathogens. Blood cultures were negativein almost half of the patients with meningitis. Resistance to the commonly employedfirst-line antibiotics (penicillin and gentamicin) is high and a chance of empiricalantibiotic use for neonates with suspected sepsis is recommended