What is Neonatal Meningitis?
Neonatal meningitis is a serious bacterial infection of the membranes covering the brain (meninges) occurring in babies within the first month of life.
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Causes
The bacteria that cause neonatal meningitis are similar to those causing newborn sepsis and pneumonia. These include:
- Streptococcus pneumoniae
- Group A and Group B streptococci
- Gram-negative enteric bacteria
Group B streptococci often live in the vagina and rectum of pregnant women and can be passed to the baby during labour, sometimes causing severe infection in the first week of life.
Symptoms in Newborns
Symptoms can be non-specific but may include:
- Temperature disturbances (fever or low temperature)
- Lethargy (unusual sleepiness) or irritability
- Vomiting and feeding difficulties
- Convulsions (seizures)
- Breathing pauses (apnoea)
- Bulging soft spot on the baby’s head (fontanel)
Management and Treatment
Neonatal meningitis requires urgent hospital care. Babies should be referred immediately after an initial dose of antibiotics is given.
Supportive care includes:
- Keeping the baby warm
- Controlling high temperature by adjusting the environment (e.g. undressing the baby); paracetamol should be avoided
- Preventing low blood sugar by encouraging breastfeeding if possible, or using a feeding tube or intravenous glucose
- Ensuring hydration and nutrition
- Providing oxygen if oxygen saturation is below 92%
Antibiotic treatment (given for 21 days):
- Ampicillin:
- For babies under 7 days old: 50-100 mg/kg given intravenously every 12 hours
- For babies over 7 days old: 50-100 mg/kg IV every 8 hours
- Gentamicin: 2.5 mg/kg IV every 12 hours
If Group B streptococci is confirmed or suspected:
- Benzylpenicillin:
- For neonates under 7 days: 50,000-100,000 IU/kg IV every 8 hours
- For older neonates: 100,000-150,000 IU/kg IV every 4-6 hours
- Plus gentamicin as above
The total treatment course lasts 3 weeks.
Blood cultures should be taken before antibiotics to identify the causative organism where possible.
