LAUSR

To the Editor: Acinetobacter baumannii sepsis can lead to meningitis and ventriculitis in neonates. Ventriculitis has been reported in 52–94% among all gram negative neonatal meningitis [1, 2] however longterm outcomes are not well reported. In this prospective observational study we assessed neurodevelopment at 2–5 y who had neonatal Acinetobacter baumannii meningitis and or ventriculitis during 2012–2016. Meningitis and ventriculitis were defined as per our unit protocol [3]. Developmental Profile (DP-3) scale [4] was used to assess development. Primary outcome was composite adverse outcome defined as death within 2 y or cerebral palsy (CP) or DP-3 score < 70 as delayed. Out of 162 culture positive cases, 87 had meningitis and or ventriculitis (53.7%). Ventriculitis was seen in 12 out of 87 (13.7%). Clinical data retrieved in 72 revealed 34 (47.2%) died, 19 (26.3%) left against medical advice who died later and 19 (26.3%) discharged. Mean (SD) gestation and birth weight of the study population were 30 (2.9) wk. and 1207 (426) g of which 27 (38%) were < 1000 g and 10 (14%) were < 28 wk. Composite adverse outcome was seen in 55 (died-53, DP3 < 70 in 2) of 60 (92%) and 12 lost in follow-up. Out of 7 followed up, 2 with ventriculitis had spastic CP with hearing deficit and significant delay in all domains of DP3 (< 40), 4 had average DP-3 (85–95) and 1 had severe hearing loss and delay in communication skill. Three of 7 (42.8%) had hearing loss with abnormal BERA, 2 had squint, 1 along with amblyopia and 1 myopia. Among 132 strains isolated in blood and CSF, 81 (61.3%) were extensively drug resistant (XDR), sensitive to colistin only and all were late onset sepsis (onset >3 d of life). Most recent DeNIS study [5] reported 82% of MDR isolates and 2/ 3rd of cases were early onset. Moderate to severe disability was observed in 28% and CP in 19% [6] following neonatal meningitis. On univariate analysis birthweight, gestation, pneumonia and septic shock were significant risk factors for death as compared to discharge cases however birth weight and pneumonia were independent risk factors for death. To conclude, neonatal Acinetobacter meningitis/ ventr icul i t is can cause signif icant mortal i ty and neurodevelopmental disabilities.