Introduction: Neonatal and infantile meningitis is recognized as a serious infection with severe mortality and morbidity. The development of hydrocephalus is widely considered to be associated with poor outcomes. But there is a paucity of data regarding post-meningitic hydrocephalus for neonates or infants in the literature.
Methods: We conducted a 20 year retrospective review to look at outcomes for hydrocephalus in post-meningitic neonates and infants and to look for factors that may affect outcomes. Poor outcome was defined as long term disability or neurological deficits. Patient’s notes and scans were reviewed. Variables recorded include sex, neonatal or infantile meningitis, time it took for hydrocephalus to develop, if the child was premature or fullterm at delivery, early or delayed hydrocephalus, organism causing meningitis, number of shunts inserted and revisions performed, reasons for shunt revision, loculations or ventriculitis and outcomes of patients.
Results: 22 patients were included in our study. Patients were aged between 1 and 10 months (mean 3.9 ± 2.8). 13 had neonatal meningitis while 9 had infantile meningitis. There were no deaths in our series. 10 (45.45%) of the patients had poor outcomes. There was no difference in outcome between neonatal and infantile meningitis. 4 patients developed early hydrocephalus while 18 patients had delayed hydrocephalus and there was no difference in outcomes between them (p=0.59). Prematurity was the only variable that was significantly associated with poor outcome (p=0.02). 9 of 22 patients underwent shunt revisions (40.9%) with blockage (4 out of 9) being the most common reason (44.4%).
Conclusions: There was no difference in outcome for neonatal and infantile meningitis. The impact of prematurity suggests that outcomes were most likely affected by the patient’s premorbid condition. When adjusted for prematurity, outcomes for post-meningitic hydrocephalus in neonates and infants may not be as poor as previously thought.
Patient Care: It will help clinicians appreciate the complexity of post neonatal and infantile meningitis associated hydrocephalus and how to manage this rare condition.
Learning Objectives: By the conclusion of the study, participants should be able to identify that CSF shunting can result in acceptable outcomes in hydrocephalus post-neonatal and infantile meningitis when done early. They will also be aware of post-meningitic hydrocephalus in neonates and infants because it is extremely rare in developed counties.