Abstract: Objective To analyze the clinical features, laboratory tests and clinical outcomes of neonates with central nervous system (CNS) infection caused by different types of pathogens. 
Methods Collected the medical records of neonates with central nervous system (CNS) infection caused by specific pathogens who were admitted to the NICU of Hebei Children′s Hospital from January 1, 2020, to December 31, 2022. Based on their pathogen results, the patients were divided into bacterial meningitis (BM) group and viral meningitis (VM) group. The clinical features, laboratory results and outcomes were compared between the two groups. 
Results A total of 63 eligible neonates were enrolled, including 38 patients in BM group and 25 in VM group. The median gestational age was 38.3 (3.0) weeks, including 47 full-term infants (74.6%) and 37 males (58.7%). The neonates had a mean birth weight of (2 970±731) g and the median age of onset was 9.6 (11.0) d. The clinical manifestations were fever (n=55, 87.3%), jaundice (n=29, 46.0%), poor feeding (n=20, 31.7%) and dystonic abnormalities (n=20, 31.7%). There was no significant difference in general clinical features and clinical manifestations between the two groups (P＞0.05). Cerebrospinal fluid (CSF) white blood cell count (WBC), abnormal ratio of WBC, percentage of polymorphonuclear cells, protein levels and blood WBC, percentage of neutrophils, C-reactive protein (CRP) and percentage of CRP>8 mg/L were higher in the BM group than that in the VM group (P＜0.05). In the BM group, the CSF WBC ranged from 6 to 258 233/mm3, which was below 20/mm3 in one infant. In the VM group, the CSF WBC ranged from 1 to 1 238/mm3, which was above 1 000/mm3 in two infants and below 20/mm3 in nine infants. E.coli (n=11, 28.9%) and Klebsiella pneumoniae (n=6, 15.8%) were the most common pathogens in BM group, and enterovirus (n=15, 60%) was the most common in VM group. The follow-up results showed that there was 1 death (2.6%) and 3 patients (7.9%) with severe neurological sequelae in the BM group, and 3 death (12%) and 1 patient (4%) with severe neurological sequelae in the VM group; The remaining patients had a good prognosis. 
Conclusion It is difficult to differentiate whether neonatal CNS infection is caused by bacteria or virus solely based on clinical features. Routine laboratory tests can be helpful to some extent in identifying pathogenic pathogens. It is crucial to detect pathogen in CSF, including viral targets, to achieve precise treatment and improve prognosis. 

Key words: central nervous system infections, pathogen, infant, newborn