- There may be history of;
- Maternal fever
- Prolonged rupture of membranes
- Foul smelling amniotic fluid.
- There may be;
- Danger signs
- Deep jaundice
- Abdominal distension
- Extensive septic skin lesions.
Note: Up to 30% of neonates with late onset sepsis will have meningitis without the obvious features of bulging fontanelle or neck stiffness.
- Full blood count; ask for a film and count of immature neutrophils. An immature to total ratio of >0.2 signifies infection.
- C-reactive protein (CRP) if available very useful for early diagnosis
- Blood culture
- Lumbar puncture
- Pus swab of any obvious septic area, e.g., umbilicus, skin
Admit the child.
Supportive Care for All Babies
- Thermal environment:
- Keep dry and well wrapped; you may need extra heat either heating the room or keeping baby in incubator according to size of the baby (minimum room temperature 26oC).
- Encourage breastfeeding if the baby is able or otherwise feed by tube. Volumes will depend on baby’s weight and age.
- If not able to tolerate enteral feed, then give IV fluid. On day 1 give 10% dextrose. Thereafter give maintenance electrolytes. Parenteral nutrition should be considered if baby is starving for longer than 3–4 days.
- Oxygen therapy:
- Give oxygen by nasal prongs or nasal catheter as needed. Do pulse oxymetry if available to monitor saturation. Oxygen can be discontinued once baby has saturations >90% in room air.
- High fever:
- Avoid antipyretics; control the environment instead. Uncover the baby for short period then cover. If baby is in incubator reduce temperature.
- • Control if present; see section under convulsions.
- Give IV penicillin and gentamicin; use cloxacillin instead of penicillin if there are skin lesions.
- If not improving in 2–3 days, change to second line: ceftazidime or ceftrioxone with amikacin OR according to sensitivity of isolated organism
- Duration of therapy: depends on response can be 7–14 days of parental therapy. For meningitis treat for 21 days
COMPLICATIONS OF MENINGITIS
The following neurological sequelae occur:
- Mental retardation
- Hearing loss
- Motor disability
- Abnormal speech patterns
The following preventive measures are important:
- Increased and improved prenatal care.
- Clean and atraumatic delivery.
- Regular cleaning and decontamination of equipment.
- Sound hand-washing principles by all personnel handling babies.
- Regular surveillance for infection.
- Early exclusive breastfeeding.