Response to Dr. Francesca Miselli et al. correspondence "early-onset meningitis with delayed presentation: Is there a role for prevention?"

We thank Francesca Miselli and colleagues for their interest in our study. The authors wonder if screening for GBS could lead to lower rates of neonatal early-onset meningitis. Screening would identify more women colonized by GBS, which would increase rates of intrapartum antibiotic prophylaxis (IAP). They ask: did the mothers of the meningitis cases with delayed (>24 h) treatment receive IAP?

All of 88 patients in our cohort had a positive blood culture and 11 (13%) also had a positive CSF culture. Ten (91%) of these meningitis cases were started on antibiotics more than 24 h after birth. Eight (80%) of these 10 cases were due to GBS. None of the mothers of the 11 meningitis cases received intrapartum antibiotic prophylaxis (IAP). Of the 77 cases with a positive blood culture only, 73 (95%) were due to GBS. The mothers of 11 (15%) of these 73 children had received IAP. This difference in IAP between mothers of GBS meningitis and GBS sepsis patients is not statistically significant (fisher exact test p = 0.37).

The authors raise important questions about the efficacy of IAP to prevent early-onset meningitis. However, the limited number of cases and observational design make our study unsuited to answer these questions. We would suggest a systematic review and meta-analysis of the, unfortunately few, randomized controlled trials to study the effect of maternal IAP to prevent neonatal meningitis as the next step.

Declaration of interests

None.