Risk factors for acute neurological complications in neonatal bacterial meningitis: a retrospective cohort study

OBJECTIVE: This study aimed to investigate the risk factors for acute neurological complications (ANCs) in neonates with bacterial meningitis (NBM). METHODS: This retrospective study analyzed 68 neonates (aged 0-28 days) with bacterial meningitis admitted to a tertiary pediatric medical center (Children's Hospital, Zhejiang University School of Medicine, China) between November 1, 2020, and June 30, 2025. ANCs were defined as a spectrum of conditions resulting from NBM, including subdural effusion/empyema, ventriculitis, hydrocephalus, brain abscess, and encephalomalacia. The cohort comprised 48 neonates without ANCs and 20 who developed ANCs. RESULTS: Compared with neonates without complications, those who developed ANCs were significantly older at symptom onset and demonstrated higher rates of seizures, elevated C-reactive protein (CRP) levels, increased cerebrospinal fluid (CSF) culture positivity, higher rates of Group B Streptococcus (GBS) infection, and more frequent dexamethasone administration. Multivariate logistic regression analysis identified seizures (OR = 10.951, 95% CI: 1.981-60.532, p = 0.006) and GBS infection (OR = 4.803, 95% CI: 1.072-21.523, p = 0.040) as independent risk factors for ANCs. Dexamethasone use (OR = 0.946, 95% CI: 0.185-4.834, p = 0.947) was not significant after adjustment. A predictive model incorporating both factors demonstrated good discriminatory capacity (AUC = 0.814, 95% CI: 0.686-0.942, p < 0.001). CONCLUSION: Seizures and GBS infection are independent risk factors for ANCs in NBM. Dexamethasone administration did not reduce the incidence of ANCs in this cohort.