Neonatal Meningitis in the New Millennium

Abstract

After completing this article, readers should be able to: 1. Describe recent changes in the incidence and outcome of neonatal bacterial meningitis. 2. Characterize the predominant responsible organisms and susceptibility of neonates to bacterial meningitis in developed countries. 3. Discuss whether routine lumbar puncture is indicated in the evaluation for sepsis/meningitis immediately after birth. 4. Characterize the duration of positive cerebrospinal fluid cultures with gram-negative bacillary meningitis. 5. Discuss the usefulness of C-reactive protein in the diagnosis and management of neonatal bacterial meningitis. 6. Describe the best predictors of an adverse outcome in neonatal bacterial meningitis. Although bacterial sepsis and meningitis often are linked closely in neonates, the frequency with which neonatal meningitis occurs relative to neonatal sepsis has decreased in recent years. Instead of one case of meningitis for every three or four cases of sepsis, it is now closer to 1 in 20, at least in developed countries. Indeed, a 1996 report from Australia documented a rate of 1 in 40 (5/209). Reports published in the past decade indicate an incidence of neonatal meningitis of 0.16 to 0.45 per 1,000 live births in developed countries. Rates may be higher in underdeveloped countries. Case fatality (mortality) rates in several recent reports from developed countries have ranged from 3% to 13% compared with 25% to 30% in reports from 15 to 20 years ago, although less developed countries still report rates of 30% to 40%. Case fatality rates vary with the causative organism, but generally are higher for gram-negative organisms. Some recent reports have suggested that the outlook for neonates who have meningitis may be improving regarding case fatality rates and neurodevelopmental outcome. Nevertheless, clinicians need to remain vigilant and investigate when sepsis and meningitis are suspected. Early treatment remains the best hope of preventing long-term deficits, although it is difficult to assess the adverse consequences …