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Understanding Bacterial Meningitis in Neonates: Causes, Diagnosis, and Treatment

Bacterial meningitis is a serious condition more prevalent in the first month of life, with mortality rates decreasing from 50% in the 1970s to 10-15% today. Despite improved survival rates, morbidity remains unchanged. The incidence of bacterial meningitis among neonates is approximately 0.25-0.32 per 1000 live births, often linked to risk factors such as low birth weight and premature birth. Early and late-onset meningitis have distinct etiologies, and prompt diagnosis and treatment are critical to improving outcomes for affected infants.

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Understanding Bacterial Meningitis in Neonates: Causes, Diagnosis, and Treatment

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Presentation Transcript

  1. Good Morning! Morning Report: Thursday, April 5th

  2. The LP…

  3. Bacterial Meningitis in the Neonate

  4. Some Background Info… • Bacterial meningitis is more common in the first month than at any other time in life • Mortality rate has declined from 50% in the 1970s to 10-15% currently • BUT, the morbidity rate is relatively unchanged • Incidence 0.25-0.32/1000 live births • Occurs in up to 15% of neonates with bacteremia

  5. Risk Factors for Neonatal Sepsis and Meningitis • LBW (<2500g) • Preterm birth (<37 wga) • PROM • Septic or traumatic delivery • Fetal hypoxia • Maternal peripartum infection • Galactosemia • Urinary tract abnormalities

  6. Etiology • Early-onset infections (first 3-6 days after birth) • Reflect vertical transmission from maternal genital tract flora • Late-onset infections (after first week of life) • Suggest nosocomial or community acquisition • (Maternal flora may still be a source)

  7. Etiology • The “bugs” • GBS • E.Coli • Other gram-negative bacilli • Other gram positive organisms constitute a higher portion of disease burden among VLBW infants • Enterococcus • Coagulase-negative staphylococci • S. aureus • L. monocytogenes • Alpha-hemolytic streptococci

  8. Clinical Features • Temperature instability (60%) • Term infants: temp> 38C • Preterm infants: temp< 36C • Neurologic symptoms • Irritability/ lethargy (60%) • Poor tone • Tremors/twitching/seizures (20-50%) • Focal • More common presentation in gram-negative meningitis • Full fontanelle

  9. Clinical Features • Other • Poor feeding/ vomiting (50%) • Respiratory distress (33-50%) • Apnea (10-30%) • Diarrhea (20%)

  10. Laboratory Work-up • Full septic work-up • CBC • BCx • UA/ UCx (if > 6 days of age) • LP • Glucose • Protein • Cell count and differential • Gram stain • Culture

  11. CSF Findings in Meningitis PEARLS OF CSF WISDOM: CSF WBC ct may be lower with gram-positive organisms In 20% of patients with culture-confirmed meningitis, the gram stain will be negative (especially with L. monocytogenes) Adjustment of WBC in the setting of a traumatic LP can result in loss of sensitivity with only a marginal gain in specificity

  12. Diagnosis • CSF culture • Negative cultures rely on cell count and protein • LP was delayed until after antibiotic administration • IAP

  13. Treatment- Empirics • Empiric therapy • Early-onset • Ampicillin and gentamicin OR • Ampicillin and cefotaxime OR • If Listeria and Enterococcus are unlikely • Ampicillin and gentamicin and cefotaxime • If a gram-negative organism is strongly suspected • Late-onset • Non-hospitalized neonates • Ampicillin and gentamicin OR • Ampicillin and gentamicin and cefotaxime • Hospitalized neonates • Vancomycin, gentamicin, cefotaxime • Vancomycin, ampicillin, gentamicin

  14. Treatment- Specifics • Specific therapy • GBS: Ampicillin or PCN+ Gentamicin sterility PCN G monotherapy • Gram-negative enterics: Ampicillin (for amp-susceptible strains), Cefotaxime+ Gentamicin sterility 7-14 days of continued combination therapy Cefotaximemonotherapy • Listeria: Ampicillin and Gentamicin • Coagulase-negative staphylococci: Vancomycin

  15. Treatment-Duration • Positive CSF culture • Gram-positives (uncomplicated course): 14 days • Gram-negatives: 21 days (minimum) • Ventriculitis, abscess, multiple areas of infarction: up to 8 weeks

  16. Complications • Acute • Ventriculitis • Abscess • Infarction • Hydrocephalus • Subdural effusion • Chronic • Developmental delay (25%) • Late-onset seizures (20%) • CP (20%) • Hearing loss (10%) • Cortical blindness (<10%)

  17. Noon is free!! Thanks for your attention!!

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