The value of an EEG performed soon (first week) after onset of neonatal bacterial meningitis in the prediction of adverse outcome at 1-19 year follow-up (mean, 4 yrs) was evaluated in 37 of 101 infants admitted and diagnosed with meningitis at the Hospital for Sick Children, Toronto, Canada. Causative organisms included Group B streptococcus in 23, and Escherichia coli in 7. Adverse outcomes occurred in 21 at 1 year and included developmental delay in 10, microcephaly (3), and seizures (3). Nine infants died, 8 in the neonatal period and 1 at 26 weeks of age.

Abnormal EEG background activity and overall description were predictive of adverse outcome, especially when EEGs were repeated. Univariate analysis showed that 14 of 16 patients with a good outcome at 1 year had a normal or mildly abnormal EEG at birth, whereas 19 of 21 with an adverse outcome had moderately to markedly abnormal EEGs. Outcome was not significantly correlated with abnormal focal or EEG seizure activity. [1]

COMMENT. A moderately-to-markedly abnormal EEG performed within 1 week of onset of neonatal bacterial meningitis is predictive of an adverse outcome at 1 year follow-up. The EEG is also of prognostic value in older infants and children with meningitis.

Even with optimal treatment, one in four children who recover from meningitis are at risk of neurodevelopmental disorders and hearing impairment [2]. Seizures and EEG abnormalities during acute meningitis are predictive of late-onset seizures and permanent neurologic deficits [3]. See Progress in Pediatric Neurology II, 1994;pp423-424, for further review of neurologic sequelae of bacterial meningitis.

Age dependence of CSF protein concentration was demonstrated in a study of traditional criteria to exclude meningitis, at St Louis Children’s Hospital, MO. CSF protein was highest and most variable in neonates (maximum 1.0 g/L), decreased rapidly to a nadir by 6 months (0.3 g/L), and gradually increased during adolescence toward adult values. Adult CSF reference values are inappropriate in the evaluation of neonates and children with suspect meningitis. [4]