Neonatal Meningitis

Excerpt

Meningitis during the neonatal period is a potentially devastating condition with dire long-term consequences. Despite advances in preventive and critical care medicine, bacterial meningitis continues to have an adverse outcome rate of 20 to 60% among its survivors. Although the incidence and mortality have declined over the past few decades, it remains challenging to diagnose due to pathogens varying with gestational age at birth, age at presentation, and geographic location, the often subtleness of clinical presentation, and inconsistent findings among infected individuals. Additionally, the use of antibiotics before cerebrospinal fluid analysis can lead to ambiguous results, and specialized testing for viral causes is often unavailable. These factors have led experts to hypothesize that this condition's true incidence and prevalence are likely much higher.

The immature immune system of neonates, especially preterm, puts them at high risk for bacterial meningitis. Their exposure during the peripartum period puts them at risk for unique bacterial and viral pathogens. The major pathogens in industrialized countries are group B Streptococcus, gram-negative rods, with Escherichia coli being the most common, and Listeria monocytogenes. However, fungal and viral causes must be considered to diagnose and treat the condition adequately. Some experts recommend that all infants with proven or suspected sepsis undergo a lumbar puncture to rule out neonatal meningitis, with the goal of early diagnosis and appropriate treatment.