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.
Antibiotics are given intravenously to treat the infection.
This infection is fatal in all untreated newborns.
Pregnant people who have a certain kind of bacteria (group B streptococci) are given antibiotics during delivery to prevent spreading the bacteria to the newborn.
(For an overview of meningitis, see Introduction to Meningitis. See also Overview of Infections in Newborns, Meningitis in adults, Meningitis in Children, and Viral Meningitis.)
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.
Symptoms of Bacterial Meningitis in Newborns
Older children with bacterial meningitis usually develop a stiff neck and have a headache. Newborns, however, do not develop a stiff neck as often as older children and adults and are unable to communicate the specifics of 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 in 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 the 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 an ultrasound or a CT or MRI scan of the brain to make sure it is safe to do a spinal tap or to look for other signs of infection in the brain.
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.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.
Prognosis for Bacterial Meningitis in Newborns
Without treatment, bacterial meningitis is fatal in nearly all newborns.
With treatment, the risk of a fatal infection 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
Pregnant people are typically screened for group B streptococci (GBS) near the end of the third trimester using samples from the vagina and rectum.
If the screening shows a pregnant person has GBS or if the person previously gave birth to a newborn who had a GBS infection, the person is given antibiotics at the time of delivery to prevent passing the bacteria to the newborn.
