1224 https://oamjms.eu/index.php/mjms/index Scientifc Foundation SPIROSKI, Skopje, Republic of Macedonia Open Access Macedonian Journal of Medical Sciences. 2021 Oct 11; 9(B):1224-1228. https://doi.org/10.3889/oamjms.2021.6706 eISSN: 1857-9655 Category: B - Clinical Sciences Section: Pediatrics The Risk Factors of Bacterial Meningitis in Late-Onset Neonatal Sepsis Ni Made Reditya Noviyani, I. Made Kardana*, Dewi Sutriani Mahalini, Ida Bagus Gede Suparyatha, Ketut Ariawati, Gusti Ayu Putu Nilawati, Made Sukmawati Department of Child Health, Faculty of Medicine, Udayana University, Sanglah Hospital, Denpasar, Bali, Indonesia Abstract BACKGROUND: Neonatal bacterial meningitis has a signifcant contribution on neonatal morbidity and mortality. It is the most common complication of late-onset neonatal sepsis. An understanding of the risk factors for bacterial meningitis in late-onset neonatal sepsis is required to provide comprehensive management. AIM: To identify the risk factors of bacterial meningitis in late-onset neonatal sepsis. METHODS: This is an analytical study with a case–control design, conducted in May 2019-February 2021, involving neonates aged 4–28 days who sufered from late-onset neonatal sepsis in Level II and III Neonatal Care Unit, Sanglah General Hospital Denpasar. Statistical analysis was performed using Chi-square and logistic regression. RESULTS: A total of 54 patients were analyzed in this study. The mean age of subjects with neonatal bacterial meningitis was 13 days and the majority of them were male (51.9%). The risk factor of bacterial meningitis in late- onset neonatal sepsis was gestational age <37 weeks with odds ratio 4.22 (95% confdence interval 1.28–13.86, p = 0.01). There was no signifcant association of birth weight <2500 g, neonatal asphyxia, and invasive procedure on neonatal bacterial meningitis. CONCLUSION: Gestational age <37 weeks is a risk factor for bacterial meningitis in late-onset neonatal sepsis. Edited by: Ksenija Bogoeva-Kostovska Citation: Noviyani NMR, Kardana IM, Mahalini DS, Suparyatha IBG, Ariawati K, Nilawati GAP, Sukmawati M. The Risk Factors of Bacterial Meningitis in Late-Onset Neonatal Sepsis. Open Access Maced J Med Sci. 2021 Oct 11; 9(B):1-5. https://doi.org/10.3889/oamjms.2021.6706 Keywords: Bacterial meningitis; Late-onset neonatal sepsis; Risk factors *Correspondence: I. Made Kardana, Department of Child Health, Faculty of Medicine Udayana University/Sanglah Hospital, Denpasar, Bali, Indonesia. E-mail: made_kardana@yahoo.com. Received: 11-Sep-2021 Revised: 21-Sep-2021 Accepted: 01-Oct-2021 Copyright: © 2021 Ni Made Reditya Noviyani, I. Made Kardana, Dewi Sutriani Mahalini, Ida Bagus Gede Suparyatha, Ketut Ariawati, Gusti Ayu Putu Nilawati, Made Sukmawati Funding: This research did not receive any fnancial support Competing Interest: The authors have declared that no competing interest exists Open Access: This is an open-access article distributed under the terms of the Creative Commons Attribution- NonCommercial 4.0 International License (CC BY-NC 4.0) Background Neonatal bacterial meningitis is an infammation of the meninges which happens during the frst 28 days of life, with evidence of the presence of bacteria in the cerebrospinal fuid (CSF). The incidence of neonatal meningitis ranges from 0.25 to 1/1000 live births and occurs in 25% of neonates with bacteremia. Approximately 10% of afected infants died and 20–50% of survivors develop seizures, hearing and visual impairments, cognitive problems, and motoric abnormalities [1], [2], [3]. The prenatal risk factors of neonatal bacterial meningitis were premature rupture of membrane, maternal vaginitis, asymptomatic bacteriuria, preterm infants, low birthweight infants, and asphyxia [4]. Neonatal bacterial meningitis is the most common complication of neonatal sepsis. In developing countries, meningitis was found in 2.4–12.7 of 7.1– 38 cases of neonatal sepsis per 1000 births [5], [6]. The prevalence of neonatal meningitis in clinical sepsis at the Neonatal Intensive Care Unit, Sanglah General Hospital Denpasar was 68.8% [7]. A study by Arora et al. also reported 55 cases of meningitis (61.11%) in 90 patients with suspected late-onset neonatal sepsis [8]. Diagnosis of neonatal bacterial meningitis is based on clinical manifestations and examination of CSF. The culture of CSF is the gold standard for diagnosing neonatal bacterial meningitis [4], [6]. Negative CSF culture in most cases of meningitis can be caused by previous use of antibiotics or incompatibility of culture media. Polymerase chain reaction (PCR) examination can be used to detect pathogens in the CSF of patients with a history of previous use of antibiotics. The PCR has a sensitivity of 86%, specifcity of 97%, a positive predictive value of 80%, and a negative predictive value of 98% compared to culture [9]. The initial manifestations of neonatal bacterial meningitis and neonatal sepsis are nonspecifc and difcult to distinguish [4]. It can cause a delay in diagnosis and in turn, afect the prognosis and survival of patients [10]. The mortality rate in neonates with meningitis in suspected late-onset sepsis was 45.5% [8]. Based on this background, we need to identify the risk factors of bacterial meningitis in late-onset neonatal sepsis at Sanglah General Hospital, Denpasar.