To explore the clinical manifestations, complications, diagnosis, treatment and prognosis in neonatal Ureaplasma parvum (Up) meningitis.

A preterm infant with early-onset Up meningitis (infant 1), who was admitted to Xuzhou Central Hospital on October 31, 2023 was included into this study. A retrospective analysis was conducted on the clinical data of infant 1, including medical history, physical examination findings at admission, relevant auxiliary examination results, and the diagnosis and treatment process. Using the search terms " Ureaplasma parvum" " meningitis" " neonate/newborn" " preterm/premature" both in Chinese and English, literature related to neonatal Up meningitis indexed in domestic databases (Wanfang Data Knowledge Service Platform, CNKI, and VIP Database) and international databases (PubMed, Embase, and Web of Science) from the inception of each database to April 2025 was searched. A comprehensive analysis of the clinical manifestations, complications, diagnosis, treatment, and prognosis of Up meningitis in newborns was conducted on the related literature. This study was in line with World Medical Association Declaration of Helsinki revised in 2013.

①Infant 1: a female preterm infant with early-onset Up meningitis born at a gestational age of 34^{+ 1} weeks, was admitted to our hospital on the day of birth due to " moaning and frothing for 30 minutes" after delivery. Antenatal vaginal swab from the mother and a postnatal nasal swab from the infant 1 both tested positive for Ureaplasma Urealyticum (UU) nucleic acid. On day 6 after admission, the infant 1 began to experience recurrent low-grade fevers accompanied by apnea. Combined with a cerebrospinal fluid white blood cell count (WBC) of 62×10⁶/L, a glucose concentration of 0.55 mmol/L, and a protein level of 1.29 g/L, metagenomic next-generation sequencing (mNGS) detected Up in the cerebrospinal fluid, with a sequence count of 154 and a relative abundance of 32.25%, Up meningitis was diagnosed. On day 7 after admission, high-dose intravenous azithromycin was initiated at 20 mg/(kg·d) once daily. The dose was reduced to 5 mg/(kg·d) once daily on day 10 after admission. From day 18 to 27 after admission, due to " intraventricular hemorrhage and severe obstructive supratentorial hydrocephalus", daily therapeutic cerebrospinal fluid aspiration (10 mL/kg) was performed. The cerebrospinal fluid parameters gradually normalized, and azithromycin was discontinued on day 27 after admission. However, the hydrocephalus did not significantly improve. On day 29 after admission, the infant 1 was transferred to another hospital for Ommaya reservoir placement. From 3 to 6 months after birth, there was no longer any need to withdraw hydrocephalus fluid, and the symptoms of hydrocephalus improved. At a corrected age of 6 months, the development of infant 1 was assessed as essentially normal. ②Literature review results: A literature search identified 15 relevant articles on neonatal Up meningitis, reporting on 16 affected neonates (infants 2-17). Including infant 1, a total of 17 neonates with Up meningitis were analyzed. Among these 17 cases, excluding one case whose gender was not reported, there were 6 males and 10 females; gestational age was not reported in one case, but the median gestational age of the remaining 16 cases was 31.5 weeks (27.3, 39.8 weeks), with 10 cases being preterm (gestational age at birth < 37 weeks); birth weight was not reported in one case, but the median birth weight of the remaining 16 cases was 1 860 g (997, 3 355 g), with 9 cases having low birth weight (birth weight < 2 500 g); the median age at onset was 7 days after birth (3.0, 10.5 days), and 9 cases were classified as early-onset (within 7 days after birth) Up meningitis. Clinically, 12 cases presented with fever, 6 with neurological abnormalities, and 4 with respiratory abnormalities. Complications included hydrocephalus in 10 cases and intracranial hemorrhage in 3 cases. The cerebrospinal fluid examination results showed an elevated WBC count (median: 608×10⁶/L), a significantly increased protein level (3.7±2.0) g/L, and a significantly decreased glucose concentration (median: 0.5 mmol/L). In 10 cases, mNGS was the sole method used to detect Up in the cerebrospinal fluid. Commonly used antibiotics for Up meningitis included erythromycin, azithromycin [often at a dose of 20 mg/(kg·d)], and quinolones, with treatment courses ranging from 3 to 10 weeks. Hydrocephalus was managed with Ommaya reservoir insertion alone in 4 cases. Regarding outcomes, follow-up information was unavailable for one infant. Of the remaining 16 cases, follow-up assessments indicated normal intellectual and motor development in 14 infants.

Neonatal Up meningitis predominantly occurs in preterm infants, with early-onset cases being the most common. The primary clinical manifestation is fever, while the incidence of neurological abnormalities is relatively low. Some infants may present with respiratory abnormalities, and the condition is frequently associated with complications such as hydrocephalus and intracranial hemorrhage. Cerebrospinal fluid analysis typically reveals an elevated WBC count, significantly increased protein levels, and markedly decreased glucose concentrations. mNGS is commonly used for the detection of Up. Macrolides and quinolones are the antibiotics of choice for treatment, while Ommaya reservoir implantation alone is the preferred approach for managing hydrocephalus. The prognosis is favorable for the vast majority of infants following treatment.