Neonatal meningitis: can we do better?

There are few data available from large, prospective, population-based neonatal surveillance studies. One of the earliest regional studies in the UK showed an incidence of neonatal bacterial meningitis of 0.5/1,000 live births over the years 1947–1960. Nearly 10 years later (1969–1973), a retrospective study of acute bacterial meningitis in the North West Metropolitan region reported a lower incidence of meningitis in neonates of 0.26/1,000 live births [ 1 ] . The first prospective, national neonatal surveillance study in the UK was performed in England and Wales over the period 1985–1987 [ 2 ] . The incidence of proven bacterial meningitis in neonates over these years was 0.22/1,000 live births, consistent with an incidence of 0.25/1,000 live births reported in a regional UK study around the same time. (1988–1991) [ 3 ] . Low birth weight and prematurity were found to be associated with a tenfold higher incidence (2.5/1,000 live births). This study was repeated 10 years later to determine whether changes in healthcare over this period had improved the outcome [ 4 ] . The overall incidence of proven bacterial meningitis however did not differ between the studies. Over the years 1996–1997 there were 0.21 cases/1,000 live births. The incidence of meningitis in neonates with low birth weight was 1.7/10,000 live births, and low birth weight and gestational age <33 weeks remained a significant risk factor. The incidence of neonatal meningitis in other developed countries is comparable to that in the UK. Surveillance undertaken by the National Institute of Health (NIH) in the USA between 1959– 1966 reported an incidence of 0.46/1,000 live births [ 5 ] while a later study conducted in California (1962–1987) showed a lower incidence of 0.3/1,000 live births. These data are consistent with European studies, for example a regional retrospective study conducted in Sweden between 1987– 1996 revealed an incidence of 0.3/1,000 live births [ 6 ] . Reports from less developed countries are variable and tend to reveal higher incidences. Community based studies in Pakistan showed an incidence of 0.81/1,000 live births, whilst in some areas in India the incidence of neonatal meningitis was reported as 4.9/1,000 live births. In Brazil, a population based study reported 4.2 cases per 1,000 child years, whilst the incidence in a rural community in Guatemala was as high as 6.1/10,000 live births [ 7 ] . Neonatal Meningitis: Can We Do Better?