A sequential guide to identify neonates with low bacterial meningitis risk: a multicenter study. Issue 5 (9th April 2021)

• Record Type: Journal Article
• Authors: Chen, Yan; Yin, Zhanghua; Gong, Xiaohui; Li, Jing; Zhong, Wenhua; Shan, Liqin; Lei, Xiaoping; Zhang, Qian; Zhou, Qin; Zhao, Youyan; Chen, Chao; Zhang, Yongjun
• Is Part Of: Annals of clinical and translational neurology. Volume 8:Issue 5(2021)
• Page Start: 1132
• Page End: 1140
• Publication Date: 2021-04-09
• Subjects: Nervous system -- Diseases -- Periodicals; Neurology -- Periodicals; 616.8005
• DOI: 10.1002/acn3.51356
• Languages: English
• ISSNs: 2328-9503

Abstract

Abstract: Objective: To derive and validate a predictive algorithm integrating clinical and laboratory parameters to stratify a full‐term neonate's risk level of having bacterial meningitis (BM). Methods: A multicentered dataset was categorized into derivation (689 full‐term neonates aged ≤28 days with a lumbar puncture [LP]) and external validation (383 neonates) datasets. A sequential algorithm with risk stratification for neonatal BM was constructed. Results: In the derivation dataset, 102 neonates had BM (14.8%). Using stepwise regression analysis, fever, infection source absence, neurological manifestation, C‐reactive protein (CRP), and procalcitonin were selected as optimal predictive sets for neonatal BM and introduced to a sequential algorithm. Based on the algorithm, 96.1% of BM cases (98 of 102) were identified, and 50.7% of the neonates (349 of 689) were classified as low risk. The algorithm's sensitivity and negative predictive value (NPV) in identifying neonates at low risk of BM were 96.2% (95% CI 91.7%–98.9%) and 98.9% (95% CI 97.6%–99.6%), respectively. In the validation dataset, sensitivity and NPV were 95.9% (95% CI 91.0%–100%) and 98.8% (95% CI 97.7%–100%). Interpretation: The sequential algorithm can risk stratify neonates for BM with excellent predictive performance and prove helpful to clinicians in LP‐related decision‐making.