Neonatal meningitis is an inflammation of the meninges that is more common in infants under 44 days old. There are two main types - early-onset caused by bacteria from the mother, usually group B strep or E. coli; and late-onset acquired from the community, usually gram-negative bacteria or staphylococcal species. Symptoms are non-specific but may include fever, irritability, and breathing issues. Diagnosis requires lumbar puncture to examine cerebrospinal fluid. Treatment involves antibiotics aimed at the suspected bacteria as well as monitoring and supportive care. Prevention focuses on vaccines for common causes and testing/treating pregnant women who test positive for group B strep.

1. Neonatal
Meningitis
Designed By: Dr. Esraa Alnabilsy

2. Introduction :
o Neonatal meningitis is a
serious medical condition
in infants.
o It’s an inflammation of the
meninges and is more common
in the neonatal period ( infants
less than 44 days old ) than any
other time in life.

3. Causes:
The most common causes of neonatal meningitis is
bacterial infection of the blood, known as bacteremia.
1) Early-onset neonatal meningitis:
• Bacteria is from the mother before the baby
is born or during birth.
• The most common bacteria found here are:
- Group B Streptococcus.
- Escherichia coli.
- Listeria monocytogenes.
- Gram-ve enteric (gut) bacteria.

4. 2) Late-onset neonatal meningitis:
• Most likely infection from the community.
• Caused by: - Gram-negative bacteria.
- Staphylococcal species.
- Streptococcus pneumoniae.
3) Herpes Simplex Virus-derived
meningitis:
• Is a rare cause of meningitis.
• HSV is transmitted to the neonate
mainly during delivery when infected
maternal secretions come into
contact with the baby
( 85% of cases ).

5. Signs:
• Fever
• Poor appetite
• Dyspnea
• Irritability
• Anorexia
• Vomiting
• Diarrhea

6. Symptoms:
• Anterior fontanelle bulging.
• Seizure.
• Jitteriness.
• Abdomminal distention (increase in abdominal size).
• Neck rigidity.
• Cyanosis.
• Jaundice.
• Sunset eyes.
• Abnormal body temprature (hypo- or hyperthermia).
• Change of activity (lethargy or irritability).

7. Signs and symptoms:
 Symptoms seen with neonatal meningitis are often
non specific that may point to several conditions,
such as sepsis (whole body inflamation).
 These can include fever, irritability, and dyspnea.
 The only method to determine if meningitis is the
cause of these symptoms is lumbar puncture (LP;
an examination of crebrospinal fluid).

9. Pathogenesis:
 The progression of neonatal meningitis starts
with bacteria colonizing the gastrointestinal
tract.
 The bacteria then invades through the
intestinal mucosa layer into the blood,
causing bacteremia followed by invasion
of the cerebrospinal fluid (CSF).
 The neonate’s less efficient immune system lessens
their defense against invading bacteria.
 Colonization of the mother plays an important role in
transmission to the neonate, causing early-onset meningitis.

10. Diagnosis :
Diagnosis of neonatal meningitis is based on both: clinical
manifestation, and CSF examination via lumbar puncture.
 CSF should be cultured.
 CSF analysis : - WBCS count.
- glucose.
- protein.
 PCR
 EEG
 CT
 US
 CBC

11. Complications:
• Hydrocephalus: abnormal accumulation of
cerebrospinal fluid (CSF) within the brain.
• Hemorrhage and cerebral infarction.
• Brain abscess formation.
• Increased intracranial pressure
• Subdural effusion or empyema ( collection of pus in the brain ).
• Ventriculitis: inflammation of the ventricles in
the brain ( especially with bacterial infection ).
• Cerebral edema ( vasogenic and cytotoxic ).

12. Treatment and Management:
It is important to start treatment as soon as possible !
Delayed treatment of neonatal meningitis may
cause cerebral palsy, blindness, deafness.
 Fluids.
 Antimicrobial agents:
medications that work
against bacteria causing
meningitis.

13.  A mix of: Ampicillin, with an aminoglycoside Gentamicin,
and 3rd generation Cephalosporin Cefotaxime is used for
early-onset meningitis before identification of infection
if it’s bacterial or viral.
 A regimen of antistaphylococcal antibiotic, such as Nafcillin
or Vancomycin, plus Cefotaxime, Ceftriaxone or Ceftazidime
with or without an aminoglycoside is recommended for
late-onset neonatal meningitis.
 In cases of herpes simplex virus-derived meningitis,
antiviral therapy Acyclovir or vidarabine.

14.  The aim for these treatments is to sterilize the CSF of any
meningitis causing pathogens.
 A repeated LP 24–48 hours after initial treatment should be
used to declare sterilization.
 Depending on the severity of the illness, the infant may
require other therapies, such as:
- Anticonvulsant medicine, if the baby is having seizures.
- Monitoring with an intracranial pressure monitoring device
placed.
- Evaluation for cerebral abscess.
- Evaluation for hydrocephalus.
Treatment and Management:

15. How to Prevent Neonatal Meningitis ?!

16.  Like with any vaccine, the vaccines that protect against
these bacteria are not 100% effective, The vaccines also
do not protect against all the types (strains) of each
bacteria.
 For these reasons, there is still a chance you can
develop bacterial meningitis even if you were
vaccinated.
 There are vaccines for three types of
bacteria that can cause meningitis:
- Neisseria meningitides.
- Streptococcus pneumoniae.
- Hib (Haemophilus Influenzae type B).

17.  Pregnant women should talk to their doctor or midwife
about getting tested for group B Streptococcus.
 Women receive the test when they are 35 to 37 weeks
pregnant.
 Doctors give antibiotics (during labor) to women who test
positive in order to prevent passing group B Strep to their
newborns.

18.  You can also help protect yourself and others from
bacterial meningitis by maintaining healthy habits:
- Don’t smoke and avoid cigarette smoke.
- Get plenty of rest.
- Avoid close contact with people who are sick.
 This is especially important for people at increased
risk for disease, including:
- Young babies.
- Older adults.
- People with weak immune systems.

19. Designed By: Dr. Esraa Alnabilsy