Neonatal Meningitis

Neonatal bacterial meningitis is inflammation of the meninges due to bacterial invasion. Neonatal bacterial meningitis occurs in 2/10,000 full-term and 2/1,000 low-birth-weight (LBW) neonates, with a male predominance.
The predominant pathogens are
*Group B streptococcus (GBS—predominantly type III)
*Escherichia coli
*Listeria monocytogenes
Enterococci, nonenterococcal group D streptococci, α-hemolytic streptococci, and other gram-negative enteric organisms (eg, Klebsiella sp, Enterobacter sp, Citrobacter diversus) also are common pathogens.
igns are those of sepsis, CNS irritation (eg, lethargy, seizures, vomiting, irritability,nuchal rigidity, a bulging or full fontanelle), and cranial nerve abnormalities.Ventriculitis frequently accompanies neonatal bacterial meningitis, particularly when caused by gram-negative enteric bacilli.
Definitive diagnosis is made by CSF examination via lumbar puncture (LP), which should be done in any neonate suspected of having sepsis or meningitis. However, LP can be difficult to do in a neonate, and there is some risk of hypoxia. Poor clinical condition (eg, respiratory distress, shock, thrombocytopenia) makes LP risky. If LP is delayed, the neonate should be treated as though meningitis is present.
Without treatment, the mortality rate for neonatal bacterial meningitis approaches 100%. With treatment, prognosis is determined by birth weight, organism, and clinical severity. Mortality rate for gram-negative neonatal bacterial meningitis is 15 to 20%.For organisms that cause vasculitis or brain abscess,the mortality rate may approach 75%. Neurologic sequelae (eg, hydrocephalus, hearing loss, intellectual disability) develop in 20 to 50% of infants who survive, with a poorer prognosis when gram-negative enteric bacilli are the cause.

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