Newborns with bacterial meningitis are usually irritable, vomit, or may have seizures.
The diagnosis is based on the results of a spinal tap and blood tests.
All untreated newborns die from the infection.
Pregnant women who have a certain kind of bacteria (group B streptococci) are given antibiotics during delivery to prevent spreading the bacteria to the newborn.
Antibiotics are given intravenously to treat the infection.
(For an overview of meningitis, see Introduction to Meningitis Introduction to Meningitis Meningitis is inflammation of the layers of tissue that cover the brain and spinal cord (meninges) and of the fluid-filled space between the meninges (subarachnoid space). Meningitis can be... read more . See also Overview of Infections in Newborns Overview of Infections in Newborns Infections occur at all ages but are a great cause for concern in newborns because newborns, especially premature ones, have an underdeveloped immune system and are more susceptible to infection... read more , Meningitis Acute Bacterial Meningitis Acute bacterial meningitis is rapidly developing inflammation of the layers of tissue that cover the brain and spinal cord (meninges) and of the fluid-filled space between the meninges (subarachnoid... read more in adults, Meningitis in Children Meningitis in Children Bacterial meningitis is a serious infection of the layers of tissue covering the brain and spinal cord (meninges). Bacterial meningitis in older infants and children usually results from bacteria... read more , and Viral Meningitis Viral Meningitis Viral meningitis is inflammation of the layers of tissue that cover the brain and spinal cord (meninges) and of the fluid-filled space between the meninges (subarachnoid space) when it is caused... read more .)
Meningitis that is caused by bacteria is life-threatening at any age but is of special concern in newborns.
Bacterial meningitis in newborns usually results from an infection of the blood (sepsis Sepsis in Newborns Sepsis is a serious bodywide reaction to infection spread through the blood. Newborns with sepsis appear generally ill—they are listless, do not feed well, often have a gray color, and may have... read more ). The infection is most commonly caused by the following bacteria:
A number of other bacteria may cause meningitis as well.
Sometimes bacterial meningitis occurs in newborns when the bacteria enter the body through cuts or punctures in the scalp. The cuts or punctures can be caused by instruments that are used for delivery or by probes that are stuck to the scalp.
Older children with bacterial meningitis usually develop a stiff neck and have a headache. Newborns rarely develop a stiff neck and are unable to communicate specific discomfort. In newborns, important signs of illness that should alert hospital staff or parents to a possibly serious problem include
Signs of sepsis Sepsis in Newborns Sepsis is a serious bodywide reaction to infection spread through the blood. Newborns with sepsis appear generally ill—they are listless, do not feed well, often have a gray color, and may have... read more (for example, temperature too high or too low, trouble breathing, yellowing of the skin and eyes [jaundice Jaundice in the Newborn Jaundice is a yellow color to the skin and/or eyes caused by an increase in bilirubin in the bloodstream. Bilirubin is a yellow substance formed when hemoglobin (the part of red blood cells... read more ], and pauses in breathing [apnea])
Abnormal drowsiness (lethargy)
Unusual fussiness and irritability (particularly a newborn who does not calm down when held)
In some newborns with meningitis, increased pressure of the fluid around the brain may make the fontanelles (the soft spots between the skull bones) bulge or feel firm.
A doctor diagnoses bacterial meningitis by removing a sample of spinal fluid obtained through a procedure called a spinal tap Spinal Tap Diagnostic procedures may be needed to confirm a diagnosis suggested by the medical history and neurologic examination. Electroencephalography (EEG) is a simple, painless procedure in which... read more (lumbar puncture). The fluid is analyzed, and if there are any bacteria in that sample, they are examined and grown (cultured Culture of Microorganisms Infectious diseases are caused by microorganisms, such as bacteria, viruses, fungi, and parasites. Doctors suspect an infection based on the person's symptoms, physical examination results,... read more ) in a laboratory for identification. Doctors also take a sample of blood to be cultured and analyzed.
Doctors may also do the PCR Polymerase chain reaction (PCR) Genetic diagnostic technologies are scientific methods that are used to understand and evaluate an organism's genes. (See also Genes and Chromosomes.) Genes are segments of deoxyribonucleic... read more test on a sample of spinal fluid. The PCR test looks for the genetic material of the bacteria and enables doctors to rapidly identify the bacteria.
A doctor may do an imaging test such as ultrasonography Ultrasonography Imaging tests of the liver, gallbladder, and biliary tract include ultrasonography, radionuclide scanning, computed tomography (CT), magnetic resonance imaging (MRI), endoscopic retrograde cholangiopancreatography... read more or CT Computed Tomography (CT) In computed tomography (CT), which used to be called computed axial tomography (CAT), an x-ray source and x-ray detector rotate around a person. In modern scanners, the x-ray detector usually... read more or MRI Magnetic Resonance Imaging (MRI) In magnetic resonance imaging (MRI), a strong magnetic field and very high frequency radio waves are used to produce highly detailed images. MRI does not use x-rays and is usually very safe... read more of the brain to make sure it is safe to do a spinal tap.
Without treatment, nearly all newborns with bacterial meningitis die.
With treatment, the risk of death is 5 to 20%. Of the newborns who survive, 20 to 50% develop serious brain and nerve problems, such as an accumulation of extra fluid in the normal open spaces within the brain (hydrocephalus Hydrocephalus Hydrocephalus is an accumulation of extra fluid in the normal spaces within the brain (ventricles) and/or between the inner and middle layers of tissues that cover the brain (the subarachnoid... read more ), hearing loss Hearing Impairment in Children Hearing loss in newborns most commonly results from cytomegalovirus infection or genetic defects and in older children results from ear infections or earwax. If children do not respond to sounds... read more , and intellectual disability Intellectual Disability Intellectual disability is significantly below average intellectual functioning present from birth or early infancy, causing limitations in the ability to conduct normal activities of daily... read more .
While awaiting culture results, the newborn is given antibiotics (often, ampicillin plus gentamicin, cefotaxime, or both) by vein (intravenously). Once the culture results are available, doctors change the antibiotics, if needed, to ones that are appropriate for the type of bacteria causing the meningitis.