**Neonatal Meningitis**

**Neonatal Meningitis**

Selim Öncel Selim Öncel Additional information is available at the end of the chapter

Additional information is available at the end of the chapter

http://dx.doi.org/10.5772/intechopen.69601

#### **Abstract**

Neonatal meningitis continues to be a problematic issue of neonatology and pediatric infectious diseases with its incidence of 0.8–6.1 in 1000 live births, high case fatality rate, and neurological sequelae. Major risk factors for contracting meningitis in the newborn period include maternal peripartum infection, premature rupture of membranes, premature birth, fetal hypoxia, septic or traumatic birth, low birth weight, and galactosemia. The leading causative agent is group B streptococci (in almost half of the cases), and a quarter of cases are due to *Escherichia coli*. Vertical transmission from the mother is often the route of infection. Neonatal meningitis may not be distinguishable clinically from neonatal sepsis without meningitis. Meticulous care should be taken to perform lumbar puncture whenever the patient's status permits since it is an indispensable tool for diagnosis. Initial empirical therapy may consist of ampicillin and cefotaxime, ampicillin and gentamicin, or ampicillin + gentamicin + cefotaxime during the first week of life. Ampicillin + gentamicin + cefotaxime for nonhospitalized infants and the same combination with the replacement of ampicillin with vancomycin for infants still in hospital are suitable options after the first week.

DOI: 10.5772/intechopen.69601

**Keywords:** infants, neonate, newborns, lumbar puncture, spinal tap, meningitis

**Core tips:** The incidence of meningitis in newborn period is so high that is incomparable to any other period in human life. The case fatality rate varies between 13 and 59% with respect to country of origin. Neurological sequelae, primarily hearing loss, continue to be an important issue with rates of 20–58% in neonates who manage to survive this relentless disease. Enteroviruses and *Enterobacter sakazakii*, which has been detected to contaminate infant formula, are emerging pathogens of neonatal meningitis. cerebrospinal fluid (CSF) glucose to serum glucose ratio is not a reliable indicator of meningitis in the first 28 days of life, because newborns often receive intravenous glucose infusions and serum glucose concentrations can rise abruptly with stress. Lumbar puncture should always be performed as soon as the infant becomes clinically stable

Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. © 2018 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

© 2016 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons

and suitable for the procedure. If *Listeria monocytogenes* grows in CSF or is suspected as the causative organism from the Gram smear, it is advisable to add ampicillin to vancomycin + gentamicin combination, because CSF concentrations of vancomycin are not bactericidal for Listeria. or regular contractions), septical or traumatic birth, fetal hypoxia, maternal peripartum infec-

Neonatal Meningitis

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http://dx.doi.org/10.5772/intechopen.69601

In economically developed countries, owing to implementation of intrapartum antibiotic prophylaxis beginning in the second half of 1990s, the incidence of early-onset group B streptococcus infections declined, whereas that of late-onset group B streptococcus infections remained the same [8]. Group B streptococci (GBS) and *Escherichia coli* are responsible for about half and a quarter of neonatal bacterial meningitis cases, respectively. These agents are succeeded in order of frequency by *Listeria monocytogenes* or Gram-negative bacteria other than *E. coli* in some texts, *Streptococcus pneumoniae*, group a streptococci, and nontypable *Haemophilus influenzae*. Gram-positive organisms other than GBS are encountered as pathogens more often in very-low-birth-weight (<1500 g) infants. Although rarely, *Neisseria meningitidis* may cause

Despite the data from economically developed countries, GBS predominance in neonatal meningitis has been observed to be replaced by Gram-negative bacteria in economically underdeveloped countries. *Klebsiella pneumoniae* is the most common Gram-negative bacillus

The most likely causative pathogens in the first three days of life are GBS, *E. coli*, other enteric bacilli, and *L. monocytogenes*. In addition to these, other Gram-negative organisms, such as *Serratia marcescens, Pseudomonas aeruginosa*, and *Citrobacter koseri*, should also be listed as likely pathogens in neonates of four days of age and older. In neonates who have left their first seven days in life behind, *Acinetobacter, Stenotrophomonas*, multidrug-resistant *Klebsiella*, and Gram-positive organisms that have not been mentioned above should be considered as causative agents [10]. Neonatal infections caused by herpes simplex virus (HSV) occur one in 3200–10,000 live births. These infections, which may manifest as neonatal meningitis, constitute 0.2% of neonatal hospitalizations and 0.6% of neonatal deaths in hospital in the United States of America [11].

Fungal meningitis occurs on the grounds of risk factors, such as prematurity, central venous catheter, congenital immunodeficiency, and long-term antibiotic therapy. The most common

Enteroviruses and *Enterobacter sakazakii*, which has been detected to contaminate infant for-

Neonates are apt to develop sepsis and meningitis more than all other individuals of all ages due to relative deficiencies in humoral and cellular immune responses. Preterm and term infants are deficient in complement in terms of quantity and quality, which leads to susceptibility to infections by encapsulated bacteria. In infants younger than 32 weeks of gestational

fungal cause of neonatal meningitis is *Candida albicans* [12].

mula, are emerging pathogens of neonatal meningitis [13, 14].

tion, galactosemia, and urinary tract infection [3].

**4. Etiology**

meningitis in newborns [3, 9].

**5. Pathophysiology**

and is followed in frequency by *E. coli*.
