NEONATAL MENINGITIS

Neonatal Meningitis

Bacterial infection of the meninges in the first month of life.

  • Organisms causing neonatal meningitis are similar to those causing neonatal septicaemia and pneumonia, i.e. S.pneumoniae, group A & B streptococci, and enteric
  • Gram-negative bacilli.
    • Meningitis due to group B streptococci: These organisms often colonise the vagina and rectum of pregnant women, can be transmitted to babies during labour, and cause infection. Meningitis and septicaemia during the 1st week after birth may be particularly severe.
  • Clinical presentation is aspecific with temperature disturbances, lethargy, irritability, vomiting, feeding problems, convulsions, apnoea, bulging fontanel

Management

Refer to hospital after initial dose of antibiotics Supportive care

  • Keep baby warm
  • For high temperature control environment (undress), avoid paracetamol
  • Prevent hypoglycaemia (breastfeeding if tolerated/possible, NGT or IV glucose)
  • Ensure hydration/nutrition
  • Give oxygen if needed (SpO2 <92%)

Empirical regimen (for 21 days)

  • Ampicillin IV
    Neonate < 7 days: 50-100 mg/kg every 12 hours
    Neonate > 7 days: 50-100 mg/kg every 8 hours
  • Plus Gentamicin 2.5 mg/kg IV every 12 hours

If group B streptococci

  • Benzylpenicillin 100,000-150,000 IU/kg IV every 4-6 hours
    Neonates <7 days: 50,000-100,000 IU/kg IV every 8 hours
  • Plus gentamicin 2.5 mg/kg IV every 12 hours
  • Continue treatment for a total of 3 weeks