ArticleBMC pregnancy and childbirth2026
A nomogram to predict probable meningitis in very preterm and/or very low birth weight infants with early-onset sepsis: a multicenter retrospective study.
Article in BMC pregnancy and childbirth, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundProbable meningitis, operationally defined by meningitis-consistent cerebrospinal fluid (CSF) abnormalities in the absence of CSF culture confirmation, is a clinically important complication of early-onset sepsis (EOS) in very preterm and/or very low birth weight (VLBW) infants.
methodsIn this retrospective multicenter cohort study, we included infants with gestational age < 32 weeks and/or birth weight < 1500 g diagnosed with EOS and admitted to three tertiary hospitals in northern China between January 2023 and December 2024. All infants underwent lumbar puncture. The primary outcome was probable meningitis, operationally defined as meningitis-consistent CSF abnormalities without CSF culture confirmation, specifically culture-negative CSF with pleocytosis, neutrophil predominance, hypoglycorrhachia, and elevated protein. Candidate predictors available at birth or within the first 24 h were prespecified. Least absolute shrinkage and selection operator (LASSO) regression with cross-validation was used for predictor selection, followed by multivariable logistic regression to develop a nomogram. Model discrimination, calibration, and clinical utility were evaluated using the C-index/AUC, Brier score, calibration plots, and decision-curve analysis with bootstrap internal validation.
resultsAmong 359 eligible infants, 88 met the study definition of probable meningitis. LASSO identified 17 candidate predictors, and the final model retained four variables: mode of delivery (cesarean delivery vs vaginal delivery), blood lactate, C-reactive protein, and procalcitonin. The nomogram demonstrated good discrimination (apparent C-index/AUC 0.861; 95% CI 0.819-0.904 [DeLong]; optimism-corrected AUC 0.855), acceptable overall performance (Brier score 0.124), and good calibration (optimism-corrected intercept - 0.035; slope 0.954).
conclusionsThis nomogram showed good discrimination and calibration for predicting probable meningitis in very preterm and/or VLBW infants with clinical EOS. It may support early risk stratification and prioritization of lumbar puncture when clinically feasible, but external validation is required before wider clinical use.
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