Note publique d'information : Les méningites néonatales bactériennes demeurent une cause de morbi-mortalité majeure
chez les nouveau-nés prématurés. Notre étude retrouve un taux de mortalité de 15.2%.
Les facteurs de risque de décès incluent le coma, une extrême prématurité (moins de
28 SA) et certaines bactéries, notamment les entérobactéries autres que E. coli. Les
complications neurologiques sont fréquentes (dans 20.9% des cas).
Note publique d'information : Introduction: Meningitis remains a major contributor to morbidity and mortality in
preterm infants, with Escherichia coli being more frequently implicated than in full-term
neonates. This study aimed to evaluate mortality, identify risk factors, assess neurological
morbidity, and examine the role of bacterial pathogens in a large national cohort.
Methods: This French multicenter retrospective study included preterm infants (<37
weeks gestation) diagnosed with neonatal meningitis before 28 days of life between
2001 and 2023. Patients were reported to a national database, ensuring broad national
representation. Results: The mortality rate was 15.2% (67/441). Increased mortality
was significantly associated with lower gestational age or birthweight, presence of
coma, septic shock, seizures, need for invasive ventilation, and elevated cerebrospinal
fluid (CSF) protein levels. E. coli and Group B Streptococcus (GBS) were the most
common pathogens, responsible for 43% and 32% of cases respectively. Multivariate
analysis identified coma (OR 13.20, p=0.009) and infection by Enterobacteriaceae excluding
E. coli (OR 28.00, p=0.017) as independent risk factors for mortality. Survival analysis
showed significantly lower survival in infants with gestational age <28 weeks (p=0.0078)
and in those presenting with coma (p<0.0001). Severe neurological complications occurred
in 20.9% of the infants, while 9.3% developed other complications such as respiratory
failure or refractory septic shock. Conclusion: neonatal meningitis in preterm infants
is associated with high mortality and morbidity. Coma, extreme prematurity, and specific
bacterial pathogens increase the risk of death. Long-term follow-up studies are essential
to better understand the outcomes in survivors.
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