The clinical features seen in neonatal meningitis are usually indistinguishable from those of neonatal sepsis. The most prevalent clinical signs include temperature instability, irritability or lethargy and poor feeding or vomiting [1]. Neurological manifestations are more commonly seen after a bacterial attack. Meningitis caused by group B streptococci may initially present with features of respiratory distress, accompanying a systemic illness. These findings become less common with an earlier age of onset.

Temperature instability presents either as fever or hypothermia and is the most commonly reported clinical feature.

Neurologic signs may include irritability, lethargy, hypotonia, muscle twitches, tremors and seizures. A more specific feature is paradoxical irritability, wherein consolation by parents irritates rather than comforts the affected neonate. Findings of a full or bulging fontanelle are not uncommon. Some patients may present with nuchal rigidity or hydrocephalus [2]. Cranial nerve lesions, especially involving the oculomotor, abducens and facial nerve may be seen in a few children.

Ventriculitis is seen accompanying neonatal meningitis in a few children, especially in those afflicted with gram negative bacilli [3]. Certain organisms (C. diversus, Cronobacter (previously Enterobacter) sakazakii) responsible for causing vasculitis along with meningitis may lead to brain cysts and abscesses. Brain abscesses may have raised intracranial tension as one of its first manifestations, thereby leading to an increase in head size and non-projectile vomiting.

• Sepsis

  A newborn male infant was admitted to the neonatal unit with suspected early onset neonatal sepsis for monitoring and intravenous antibiotics. [ncbi.nlm.nih.gov]

  Contact Our Team What Causes Neonatal Sepsis and Meningitis? Another infection : For instance, meningitis can trigger sepsis and sepsis can trigger meningitis. [michigancerebralpalsyattorneys.com]

  and should be considered in all neonates in whom sepsis is a possibility. [doi.org]

• Fever

  The symptoms were fever and seizures. The culture of cerebrospinal fluid showed to be positive for Neisseria meningitidis B. culture blood was negative. Antibiotic therapy was started at admission and maintained for 3 weeks. [ncbi.nlm.nih.gov]

  The mother usually experienced a flu-like illness late in the third trimester of pregnancy, characterized by low-grade fever, myalgias, malaise, and backache. [labce.com]

  Symptoms include sepsis, fever, irritability, and dyspnea. It can be caused by Escherichia coli (E. coli), and in rare cases, listeria monocytogenes (listeria). [imedpub.com]

• Poor Feeding

  The most prevalent clinical signs include temperature instability, irritability or lethargy and poor feeding or vomiting. Neurological manifestations are more commonly seen after a bacterial attack. [symptoma.com]

  Besides, we found that the poor feeding, pneumonia and CSF protein were predictive of poor outcome in our study. Weber et al found that reduced feeding ability may be an independent predictor of severe disease [ 27 ]. [journals.plos.org]

  Common symptoms include poor feeding, lethargy, vomiting, respiratory distress, and temperature instabilities ( 11 ). In our study, the most common clinical manifestations were poor feeding, seizures, and tachypnea. [ncbi.nlm.nih.gov]

• Cerebral Palsy

  Brain damage Cognitive impairments Cerebral palsy Edema (fluid buildup in the brain) Brain abscesses (pus-filled pockets) Cerebral palsy Developmental delays Seizure disorders Learning disabilities What Are the Signs and Symptoms of Neonatal Sepsis and [michigancerebralpalsyattorneys.com]

  Pre-term infants with sepsis are noted to have higher rates of cognitive deficits, cerebral palsy, and other neurological disabilities. [abclawcenters.com]

• Weakness

  The patient's clinical course was excellent and inflammatory indications, such as serum C-reactive protein, were weak. [ncbi.nlm.nih.gov]

  The clinical examination showed an axial hypotonia with a bulging anterior fontanel, were weak, in addition to an omphalitis, a polymalformative syndrome comprising ruptured myelomeningocele which was infected, congenital bilateral hip dislocation, arthrogryposis [eurekalert.org]

  Imagine that this is the result: beta-hemolysis on sheep blood agar Although it is slightly weak, the region in the middle of the plate from which bacteria has been removed demonstrates beta-hemolysis. [andrewtmckenzie.com]

  […] non-responsiveness Low urine output Lethargy and hypotonia (decreased muscle tone) Meningitis : Failure to respond to antibiotic therapy Respiratory depression Growth of a soft spot (bulging fontanelle) Fast head growth Separation of parts of the skull Weakness [michigancerebralpalsyattorneys.com]

• Abdominal Distension

  On the fourth day, the baby developed lethargy, refused to feed, and developed abdominal distension. The baby was referred to the neonatal intensive care unit at Sir Ganga Ram Hospital on the sixth day of life. [journals.lww.com]

  Fever, irritability, seizures and a bulging fontanel were significantly more frequent among newborns whose birth weight was > " 2500g, whereas abdominal distension, apnea, jaundice and blood count abnormalities were predominant among low-birth weight [scielo.br]

• Jaundice

  On physical examination, the neonate appeared toxic, listless, and jaundiced and was actively vomiting. [acepnow.com]

  Neonates with good outcome had less frequent apnea, drowsiness, poor feeding, bulging fontanelle, irritability and more severe jaundice compared to neonates with poor outcome. [journals.plos.org]

• Hypotension

  […] pathogens include E. coli and Listeria monocytogenes. 1 The cumulative incidence of meningitis is highest in the first month of life and is higher in preterm neonates than term neonates. 2 Patients may present with difficulty feeding, apnea, bradycardia, hypotension [acepnow.com]

  The recognition and treatment of hypotension is particularly important to avoid complications such as cerebral ischaemic... Read more... [health.vic.gov.au]

  Meningococcal meningitis and/or septicaemia may also present with capillary refill time more than two seconds, unusual skin colour and hypotension. [patient.info]

• Hypertension

  Adverse effects of corticosteroid therapy include glucose intolerance, systemic hypertension, benign intracranial hypertension, poor response to infection and injury, easy bruising, cataracts and gastrointestinal bleeding ( Rang 2003 ). [cochranelibrary.com]

• Hip Dislocation

  The clinical examination showed an axial hypotonia with a bulging anterior fontanel, were weak, in addition to an omphalitis, a polymalformative syndrome comprising ruptured myelomeningocele which was infected, congenital bilateral hip dislocation, arthrogryposis [eurekalert.org]

• Cesarean Section

  Pregnant women with a herpes simplex infection may be put on anti-virals before birth or may opt for a Cesarean section to avoid infecting the baby during delivery. [livestrong.com]

  The mean age at onset of meningitis was 13.0 ± 7.7 days. 92 (39.7%) neonates were born by cesarean section (CS), and 140 (60.3%) neonates were vaginal deliveries. The mean birth weight was 3072 ± 422 g. [journals.plos.org]

• Seizure

  Several factors for poor prognosis in newborns with culture-proven bacterial meningitis were found: high CSF protein concentration, congenital heart disease, hearing impairment, and seizure. [ncbi.nlm.nih.gov]

  Seizures and EEG abnormalities during acute meningitis are predictive of late-onset seizures and permanent neurologic deficits [ 3 ]. [pediatricneurologybriefs.com]

  /F None Seizures NA Died 3 3 8 days/M None Seizures NA Died 3 4 17 days/F Umbilical sepsis None Penicillin Recovered/NA 4 5 3 days/F Necrotizing fasciitis, septicemia None Penicillin Recovered 5 6 14 days/F Erysipelas Seizures, D.I.C*. [casesjournal.biomedcentral.com]

  For example, if a baby shows signs of neonatal seizures, they may need anticonvulsant medications. Magnetic resonance imaging (MRI) should be performed before antibiotics are discontinued (4). [abclawcenters.com]

• Bulging Fontanelle

  Findings of a full or bulging fontanelle are not uncommon. Some patients may present with nuchal rigidity or hydrocephalus. Cranial nerve lesions, especially involving the oculomotor, abducens and facial nerve may be seen in a few children. [symptoma.com]

  Upon admission the infant was more alert and appeared hungry, but still was irritable and had a bulging fontanelle. At 24 hours after ER presentation, he was acting like a normal infant and the fontanelle had decreased a great deal. [pediatriceducation.org]

  The newborn may not have a bulging fontanelle or a stiff neck. The most common causative organisms in this age group are Group B or Group D Strep, Listeria, and Entero-bacteraceae. Diagnostic tests: Most important is the LP. [calsprogram.org]

  Signs suggestive of meningeal irritation, including stiff neck, bulging fontanelle, convulsions, and opisthotonus, occur only in a minority of neonates with bacterial meningitis and cannot be relied on solely to identify such patients. [ncbi.nlm.nih.gov]

• Convulsions

  The second newborn was conscious, febrile with signs of sepsis and convulsions including chewing, boxing and revulsion of the eyes with signs of respiratory and circulatory distress. [eurekalert.org]

  On admission to the hospital on the sixth day, he had three episodes of apnoea and stiffness consistent with a tonic convulsion. [cirp.org]

  11% Convulsion and bulging fontanelle 7% Convulsion, bulging fontanelle and neck stiffness 1% 10. [slideshare.net]

  Signs suggestive of meningeal irritation, including stiff neck, bulging fontanelle, convulsions, and opisthotonus, occur only in a minority of neonates with bacterial meningitis and cannot be relied on solely to identify such patients. [ncbi.nlm.nih.gov]

  Fever, vomiting, irritability, and convulsions usually occur. A high-pitched cry, and a bulging or tight soft spot (fontanel) on the crown of the head (where the parts of the still unhardened bones join) may also occur. [rarediseases.org]

• Stupor

  Stupor and irritability are common in late-onset meningitis as are neurological complications. [acepnow.com]

  Symptoms among older children and adults may progress from irritability through confusion, drowsiness, and stupor, possibly leading to coma. [rarediseases.org]

  […] macular, mucosal) Tachypnea or apnea Jaundice Bulging fontanelle (late) Vomiting or diarrhea Altered sleep pattern PHYSICAL EXAMINATION In the physical examination of a newborn or infant with meningitis, findings may range from completely normal to stupor [aafp.org]

• Opisthotonus

  Signs suggestive of meningeal irritation, including stiff neck, bulging fontanelle, convulsions, and opisthotonus, occur only in a minority of neonates with bacterial meningitis and cannot be relied on solely to identify such patients. [ncbi.nlm.nih.gov]

  Stiff neck (generally not present in children under the age of one year or in patients with altered mental state), back rigidity, bulging fontanelle (in infants), photophobia, opisthotonus (if severe). [patient.info]

  Late in the illness, classical features of raised intracranial pressure such as full and tense fontanelles, setting‐sun eye appearance, retrocollis, opisthotonus (when the neck of the infant is twisted backwards) and seizures can occur. [cochranelibrary.com]

Meningitis is associated with an increased risk of mortality in neonates and hence, there should be no delay in the workup of a neonate suspected of suffering from meningitis. A lumbar puncture is the gold standard test to be done in such neonates, even in the absence of neurological manifestations.

The major findings seen on cerebrospinal fluid (CSF) analysis include an elevated CSF protein, decreased CSF glucose and pleocytosis, with polymorphonuclear leucocytes dominating the picture in both bacterial and viral meningitis. All three parameters need to be normal for a diagnosis of meningitis to be excluded [4]. Symptomatic neonates should also undergo a CSF culture for confirmation of the diagnosis. It has been found though, that 15-30% of CSF-proven cases have negative blood culture results [5].

Another modality with higher sensitivity and specificity rates to detect neonatal meningitis is the polymerase chain reaction (PCR) assay, that is being increasingly used to detect the presence of organisms such as group B streptococci, herpes simplex virus, enterovirus etc [6] [7].

Urinary latex particle agglutination (LGA) is another method designed to rapidly screen neonates for meningitis.

The neuroimaging study of choice is magnetic resonance imaging (MRI) that may help to locate the foci of infection, areas of edema, hemorrhage, infarction or abscesses. Follow-up scans may help evaluate the resolution of infection. Newer MRI techniques such as diffusion-weighted scans and diffusion tensor imaging are being used to note any white matter changes associated with neonatal meningitis [8].

Computed tomography (CT) scans may appear to be beneficial in patients posted for neurosurgery, whilst cranial ultrasonography may be useful to document ventricle size in hydrocephalus. Chest radiography and electroencephalography (EEG) studies may be done in some cases.

• Streptococcus Pneumoniae

  Resumen Streptococcus pneumoniae is a rarely recognized cause of neonatal sepsis and/or meningitis, but it is associated with substantial morbidity and mortality. [repositorio.uchile.cl]

  Causative organisms were group B Streptococcus pneumoniae, Klebsiella pneumonia, Pseudomonas species, Neisseria meningitidis, Staphylococcus epidermidis and Flavibacterium meningococcus septicum. [ncbi.nlm.nih.gov]

  Key species of interest are: Streptococcus pneumoniae Neisseria meningitidis Streptococcus agalactiae Key research areas of research are: Evolution of vaccine evasion Genetics of pathogenesis Genetics of transmission and spread Read More People Professor [sanger.ac.uk]

  […] type b (Hib), group B Streptococcus Teens and young adults: Neisseria meningitidis, Streptococcus pneumoniae Older adults: Streptococcus pneumoniae, Neisseria meningitidis, Haemophilus influenzae type b (Hib), group B Streptococcus, Listeria monocytogenes [cdc.gov]

  In developing countries, Streptococcus pneumoniae accounts for most cases of late onset. [en.wikipedia.org]

• Staphylococcus Aureus

  aureus, Listerisa monocytogenes, Neisseria meningitidis, Haemophilus influenzae, Streptococcus pneumoniae, and Streptococcus agalactiae. [ncbi.nlm.nih.gov]

  Outbreaks of infections such as Staphylococcus aureus, Streptococcus spp., E. coli, and S. enterica have chiefly occurred when expressed milk has not been correctly handled or stored. [jcm.asm.org]

  Etiology The predominant pathogens are Other reported pathogens include Enterococci, nonenterococcal group D streptococci, alpha-hemolytic streptococci, Staphylococcus aureus, coagulase-negative staphylococci, and gram-negative enteric organisms (eg, [merckmanuals.com]

  The bacteria most frequently identified in the CSF were Enterobacteria (41% of the cases, Table 3 ), followed by Streptococcus B (17.5%), non-B-type strain Streptococcus (17.5%), Staphylococcus aureus (11.7%), Neisseria meningitidis (8.8%) and Enterococcus [scielo.br]

• Lumbar Puncture Abnormal

  Clinicians frequently use the presence of positive blood cultures to determine whether neonates should undergo lumbar puncture. [ncbi.nlm.nih.gov]

Follow-up MRI was performed in five of the neonates in the patient group after 2 weeks of antibiotic treatment. FA and MD values were compared in patients before and after antibiotic treatment as well as with those in the healthy controls. [ncbi.nlm.nih.gov]

The aim for these treatments is to sterilize the cerebrospinal fluid of all pathogens. A repeat spinal tap 24 to 48 hours after treatment has been started should be done to confirm sterilization. [en.wikipedia.org]

Patients with the outcomes of death and having sequelae were regarded as having a poor prognosis. Those who were lost to follow-up were excluded from the analysis of outcome. [ncbi.nlm.nih.gov]

Early recognition of neonates at risk of poor prognosis would be helpful in providing timely management. [journals.plos.org]

In this study the main etiological agent identified from CSF culture was S. pneumoniae. [springerplus.springeropen.com]

The histologic diagnosis therefore is suppurative meningitis, with culture results necessary to establish the etiologic agent. [labce.com]

Coagulase-negative staphylococci were considered to be the etiological agent of meningitis only when they was isolated in CSF and blood cultures at the same time. [scielo.br]

BACTERIAL ETIOLOGIES Typical pathogens vary with age ( Table 4 ). In the first month of life, group B streptococcus is the most common etiologic agent. [aafp.org]

The epidemiological findings suggest that the cases reported from Malaysia were community-acquired in contrast with those from the USA and Thailand. [ncbi.nlm.nih.gov]

Transmission and Epidemiology (Escherichia coli) Occurs most often in premature babies, with a 20% mortality rate, even with aggressive treatment. Those who survive have permanent brain damage. [quizlet.com]

Over the past few years, major progress has been made in the understanding of the pathophysiology of E. coli O18:K1:H7 neonatal meningitis. [ncbi.nlm.nih.gov]

Noninfectious meningitis Sarcoidosis Tumor metastases (meningeal carcinomatosis and meningeal leukemia ) Medication (e.g., NSAIDs ) References: [1] [2] [3] [4] [5] [6] Pathophysiology Most pathogens that cause meningitis colonize the nasopharynx or the [amboss.com]

Pathophysiology and management of the newborn, 5a, pp. 1189-1230 [13.] M.B. Synnott, D.L. Morse. Neonatal meningitis in England and Wales: A review of routine national data. Arch Dis Child, 71 (1994), pp. 75-80 [14.] R.F. Kornelisse, R. Groot, H.J. [analesdepediatria.org]

It is suggested that the identification and appropriate treatment of any maternal bacterial infection is an important measure in preventing neonatal sepsis and meningitis. [ncbi.nlm.nih.gov]

Currently, the best means of neonatal GBS prevention is the use of maternal IAP to prevent early onset GBS disease. However, IAP only prevents early onset GBS disease, 38 and the majority of GBS meningitis cases are of late onset. [doi.org]

Prevention of neonatal meningitis is primarily intrapartum (during labor) antibiotic prophylaxis (prevention) of pregnant mothers to decrease chance of early-onset meningitis by Streptococcus agalactiae. [en.wikipedia.org]

Prevention and Treatment (Cronobacter sakazakii) -FDA and CDC advise hospitals to use ready-to-feed and concentrated liquid formulas. [quizlet.com]

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4. Garges HP, Moody MA, Cotten CM, et al. Neonatal meningitis: what is the correlation among cerebrospinal fluid cultures, blood cultures, and cerebrospinal fluid parameters?. Pediatrics. 2006 Apr. 117(4):1094-100.
5. Malbon K, Mohan R, Nicholl R. Should a neonate with possible late onset infection always have a lumbar puncture?. Arch Dis Child. 2006 Jan. 91(1):75-6.
6. Tebruegge M, Curtis N. Enterovirus infections in neonates. Semin Fetal Neonatal Med. March 2009. 1-6.
7. Kimberlin D. Herpes simplex virus, meningitis, and encephalitis in neonates. Herpes. 2004. 11 Supp 2:65A-76A.
8. Shah DK, Daley AJ, Hunt RW, Volpe JJ, Inder TE. Cerebral white matter injury in the newborn following Escherichia coli meningitis. Eur J Paediatr Neurol. 2005. 9:13-17.