**6. Physical examination**

Clinical findings of neonatal meningitis are similar to those of neonatal sepsis with or without meningitis. It is not possible to predict with physical examination alone whether the infant has sepsis, meningitis or both. The most common (60%) finding is the alteration in body temperature. This alteration may become manifest as either fever (>38°C) or hypothermia (<36°C). Fever is usually observed in term infants, whereas preterms have a stronger tendency to develop hypothermia [3]. Skin vesicles should suggest HSV in the etiology of meningitis,


**Table 1.** Physical examination findings found in neonatal meningitis and their frequencies [1, 3].

but vesicles may not appear in the early stages or may not occur at all through the course of the disease as is the case in 20% of the newborns with systemic HSV infection. In the absence of vesicles, it is impossible to differentiate HSV meningitis from bacterial meningitis or meningitis due to other agents [11]. Seizures are seen more often in Gram-negative bacterial meningitis rather than in meningitis caused by Gram-positive bacteria. It is inadvisable to rely on the presence of bulging anterior fontanel or nuchal rigidity, because only a few infants (25 and 15%, respectively) with meningitis demonstrate these signs [3]. Neurologic signs usually appear after the second day, whereas mainly systemic signs predominate in the first 48 h. Physical examination findings in neonatal meningitis and their frequencies are summarized in **Table 1**.
