Retrospective review of neonatal bacterial meningitis outcomes and pathogen associations in 531 term neonates

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medRxiv Published April 23, 2026 Medically reviewed May 24, 2026 Study authors: Ying, C.; Du, Y.; Wu, J.; Zou, P.; Zhang, L.; Li, Y.; Wang, Y. j. DOI ↗ By Dr. Sofia Müller, MD · Lifespan & Whole-Person Care

Key Takeaway

Note pathogen-specific imaging complication associations in neonatal meningitis within this retrospective cohort.

This retrospective study examined 531 term neonates diagnosed with neonatal bacterial meningitis at the Capital Institute of Pediatrics. The analysis focused on clinical characteristics, imaging complications, discharge outcomes, and laboratory parameters, comparing pathogen-positive versus pathogen-negative groups and favorable versus adverse discharge outcomes. The follow-up duration was not reported.

Key findings showed that abnormal body temperature occurred in 79.85% of cases, altered consciousness in 55.18%, and jaundice in 46.52%. CSF/blood culture positivity was observed in 133 cases (25.05%). The overall incidence of imaging complications was 22.22%, with hydrocephalus at 5.84%, subdural effusion at 4.90%, and encephalomalacia at 2.64%. Adverse discharge outcomes were reported in 107 cases (20.15%).

The study identified associations between predominant pathogens and specific complications: Gram-negative infections were associated with higher hydrocephalus and subdural effusion rates; Gram-positive infections with higher brain abscess risk; Escherichia coli with hydrocephalus and subdural effusion; group B streptococcus with cerebral infarction and encephalomalacia; and LM with intracranial hemorrhage and brain abscess. Negative cultures correlated with no imaging complications. All associations had P<0.05. Limitations include the retrospective nature of the study, which precludes causal conclusions, and the lack of reported safety data or follow-up duration.

Study Details

EvidenceLevel 5

PublishedApr 2026

View Original Abstract ↓

Objective: To describe the clinical characteristics of term neonates with neonatal bacterial meningitis (NBM) and explore the association between different pathogens and imaging complications, providing clinical evidence for early identification and individualized management. Methods: A retrospective study was conducted on 531 term neonates diagnosed with NBM admitted to the Capital Institute of Pediatrics from 2013 to 2025. Demographics, clinical manifestations, laboratory parameters, etiological results, imaging complications and treatment measures were collected. Patients were divided into favorable/adverse discharge outcome groups and pathogen-positive/negative groups. Statistical analyses were performed using appropriate tests, and Cramers V coefficient was used to analyze the association between pathogens and imaging complications. Results: (1) The most common clinical manifestations were abnormal body temperature (79.85%), altered consciousness (55.18%) and jaundice (46.52%). CSF/blood culture was positive in 133 cases (25.05%), with Escherichia coli (27.07%), group B streptococcus (17.29%) and Staphylococcus species (16.54%) as predominant pathogens. The overall incidence of imaging complications was 22.22%, mainly hydrocephalus (5.84%), subdural effusion (4.90%) and encephalomalacia (2.64%). (2) Adverse discharge outcomes occurred in 107 cases (20.15%). Compared with the favorable group, the adverse group had higher incidences of convulsions, altered consciousness, anterior fontanelle bulging, abnormal muscle tone and primitive reflexes (all P<0.001), more obvious laboratory abnormalities (higher CRP, CSF leukocytes and protein, lower CSF glucose, all P<0.05), higher culture positive rates and greater need for adjuvant therapy (all P<0.001). (3) Pathogen-positive patients had higher imaging complication rates. Gram-negative infections were associated with higher hydrocephalus and subdural effusion rates, while Gram-positive infections had higher brain abscess risk. Specifically, Escherichia coli correlated with hydrocephalus and subdural effusion; group B streptococcus with cerebral infarction and encephalomalacia; LM with intracranial hemorrhage and brain abscess; negative cultures correlated with no imaging complications (all P<0.05). Conclusion: Term NBM neonates have non-specific manifestations, mainly abnormal body temperature and altered consciousness. Predominant pathogens are Escherichia coli, group B streptococcus and Staphylococcus species, with hydrocephalus and subdural effusion as common imaging complications. Adverse outcomes are associated with severe symptoms, obvious laboratory abnormalities and higher pathogen positivity. Specific pathogens correlate with distinct imaging complications.