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Bacterial Meningitis in Newborns


Brenda L. Tesini

, MD, University of Rochester School of Medicine and Dentistry

Last full review/revision Jul 2020| Content last modified Jul 2020
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Bacterial meningitis is inflammation of the layers of tissue surrounding the brain and spinal cord (meninges) caused by bacteria.

  • 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.

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). The infection is most commonly caused by the following bacteria:

  • Group B streptococci

  • Escherichia coli

  • Listeria monocytogenes

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.

Symptoms of Bacterial Meningitis in Newborns

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 (for example, temperature too high or too low, trouble breathing, yellowing of the skin and eyes [jaundice], and pauses in breathing [apnea])

  • Abnormal drowsiness (lethargy)

  • Vomiting

  • 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.

Diagnosis of Bacterial Meningitis in Newborns

  • Spinal tap

  • Blood tests

  • Polymerase chain reaction (PCR) test

  • Sometimes ultrasonography or computed tomography (CT) or magnetic resonance imaging (MRI) of the brain

A doctor diagnoses bacterial meningitis by removing a sample of spinal fluid obtained through a procedure called a spinal tap (lumbar puncture). The fluid is analyzed, and if there are any bacteria in that sample, they are examined and grown (cultured) in a laboratory for identification. Doctors also take a sample of blood to be cultured and analyzed.

Doctors may also do the PCR 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 or CT or MRI of the brain to make sure it is safe to do a spinal tap.

Prognosis of Bacterial Meningitis in Newborns

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), hearing loss, and intellectual disability.

Prevention of Bacterial Meningitis in Newborns

While pregnant, women are typically screened for group B streptococci (GBS) in their genital tract. Pregnant women who have GBS may be given antibiotics at the time of delivery to prevent passing the bacteria to the newborn.

Treatment of Bacterial Meningitis in Newborns

  • Antibiotics

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.

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