In addition to antibiotics, dexamethasone a steroid may also be given to children over six weeks of age who have acute bacterial meningitis. However, earlyonset sepsis remains one of the most common causes of neonatal morbidity and mortality in the preterm population. Characterize the predominant responsible organisms and susceptibility of neonates to bacterial meningitis in developed countries. Management of bacterial meningitis in infants pdf source. Practice guidelines for the management of bacterial meningitis. The authors recommended the use of cephalosporins rather than chloramphenicol and advocated intraventricular aminoglycoside treatment in selected. Even with appropriate treatment, morbidity and mortality can be substantial. Contributing factors to such mortality and morbidity include our incomplete knowledge on the pathogenesis of how meningitiscausing bacteria penetrate the blood brain barrier, emergence of antimicrobial resistance, and difficulty in early diagnosis of meningitis.
Neonatal meningitis is a serious medical condition in infants that is rapidly fatal if untreated. Treatment for bacterial meningitis usually involves intravenous iv antibiotics. In order to improve prognosis of the infection, early diagnosis and prompt treatment are crucial to prevent mortality and the incidence of neurologic sequelae that cause longterm. Neonatal meningitis in the new millennium american academy. Meningitis is an inflammation of the meninges, the protective membranes of the central nervous system, is more common in the neonatal period infants less than 44 days old than any other time in life, and is an important cause of morbidity and mortality globally. Assessment and care page 4 of 51 introduction there have been many advances in prevention, assessment and treatment of neonatal sepsis in the past few decades. They noted the absence of clinical trials with third generation cephalosporins that showed an.
Pharmacists should ensure that local antibiotic guidelines reflect this, along with local resistance patterns, to ensure initial treatment is appropriate. Management of neonates with suspected or proven earlyonset. Neonatal bacterial meningitis american academy of pediatrics. Despite advances in infant intensive care, neonatal meningitis remains a devastating disease with considerable risk of mortality and morbidity. Management of neonates with suspected or proven early. Neonatal bacterial meningitis pediatrics msd manual. Bacterial meningitis is a severe, lifethreatening infection of the central nervous system that requires immediate medical attention. Sep 19, 2011 neonatal meningitis diagnosis and treatment. Prevention of neonatal sepsis, early recognition of infants at risk, prompt treatment and future adjunctive therapies will improve prognosis. The incidence rate for neonates and infants is 20100,000. Treatment of neonatal enterovirus infections journal of the.
Mortality rate for treated neonatal bacterial meningitis is 5 to 20%. Sep 01, 2015 neonatal bacterial meningitis continues to be an important cause of mortality and morbidity. Dexamethasone should be administered 1020 min before antimicrobial therapy for maximal efficacy and continued for 24 days. The neurologic complications of bacterial meningitis in the neonate will be discussed here. The earlier the treatment is initiated, the better your childs outcome. Pubmed is a searchable database of medical literature and lists journal articles that discuss neonatal meningitis. On his 23rd day of life dol, a baby boy was transferred to our medical center from a community emergency department for treatment and management of presumed neonatal sepsis and meningitis. Bacterial meningitis in infants meningitis because of bacterial metabolism of glucose in the csf. In developed countries, the rate of mortality from bacterial meningitis among neonates has declined from almost 50% in the 1970s to less than 10% in the late 1990s.
Neonatal meningitis is a common cause of death and longterm disability among children everywhere, particularly in developing countries. Neonatal meningitis is a type of bacterial meningitis that can be caused by many organisms including group b streptococcal, e. The authors recommended the use of cephalosporins rather than chloramphenicol and advocated. The only intervention proven to decrease the incidence of earlyonset neonatal sepsis is maternal treatment with intrapartum intravenous antimicrobial agents for the prevention of gbs infections. However, the morbidity and mortality associated with sepsis remains high for susceptible neonates. Click on the link to view a sample search on this topic. The objective of these practice guidelines is to provide clinicians with recommendations for the diagnosis and treatment of bacterial meningitis.
Information for the public intraventricular antibiotics for bacterial meningitis in neonates. The clinical features, diagnosis, and treatment of bacterial meningitis in neonates are discussed separately. Bacterial meningitis is an important cause of death both in the developed and developing world. Treatment of neonates with suspected sepsis or meningitis should commence as soon as appropriate cultures and intravenous access can be obtained. Antibiotic use for sepsis in neonates and children. The management of neonatal meningitis paediatrics and child. Neonates are at high risk of meningitis and of resulting neurologic complications.
Neonatal bacterial meningitis continues to be an important cause of mortality and morbidity. However, if treatment is delayed or improper, neonatal meningitis can result in serious disabilities such as cerebral palsy, seizure disorders, and developmental issues such as vision and hearing impairments 2. In order to improve prognosis of the infection, early diagnosis and prompt treatment are crucial to. Although the occurrence of neonatal meningitis is uncommon, it remains a devastating infection with high mortality and high morbidity. Diagnosing and treating meningitis in babies in a neonatal. Discuss whether routine lumbar puncture is indicated in the evaluation for sepsis meningitis immediately after. Aj pollard, a cloke, sn faust, l glennie, c haines, js kroll, m levin, i maconochie, s mcqueen, s nadel, p monk, mp richardson, mj thompson, ap thompson. The mortality rate has declined from almost 50 percent in the 1970s to contemporary rates of 7 to 18 percent 25.
Feb 12, 2018 neonatal meningitis is often caused by group b streptococcus and is associated with prematurity, gestational age, postnatal age, and geographic region. Treatment neonatal septicemia is a severe disease with high mortality. Free or intracellular bacteria may be observed in some cases. Antibiotic treatment of suspected neonatal meningitis. Corrected gestational age neonatal dosing guideline in place of ceftriaxone. Pdf twelve years ago an annotation was published in archives of disease in childhood regarding the antibiotic treatment of suspected neonatal. Refer to neonatal dosing guideline for antibiotic doses and intervals. Use of corticosteroids for treatment of the newborn with. Neonatal bacterial meningitis pediatrics merck manuals. Clinical prognosis in neonatal bacterial meningitis.
Bacterial meningitis is a severe infectious disease of the membranes lining the brain resulting in a high mortality and morbidity throughout the world. It can be treated with appropriate antibiotics that also prevents spread. An uncontrolled study of patients given pleconaril under a treatment investigational new drug application ind, including 6 neonates, suggested efficacy against serious enterovirus infections 10. An early empiric antibiotic treatment is critical for the management of neonates with bacterial meningitis, but early recognition of neonatal.
Neisseria meningitidis is the most common etiological factor for bm in the european countries. Bacterial meningitis is very serious because its onset is rapid and the infection is associated with a significant risk of death. Because distinguishing viral from bacterial meningitis is. Diagnosis and treatment of bacterial meningitis archives. Feb 28, 2018 despite advances in infant intensive care, neonatal meningitis remains a devastating disease with considerable risk of mortality and morbidity. Contributing factors to such mortality and morbidity include our incomplete knowledge on the pathogenesis of how meningitis causing bacteria penetrate the blood brain barrier, emergence of antimicrobial resistance, and difficulty in early diagnosis of meningitis. Mar 03, 2012 if treated quickly and appropriately, infants with meningitis should make a full recovery.
For information about bacterial meningitis for babies not in neonatal units or to read the information for the public about the bacterial meningitis and meningococcal. Despite the institution of maternal intrapartum prophylaxis, group b streptococcus gbs has remained the most common cause of neonatal sepsis and meningitis since the early 1980s, responsible for 40% of all earlyonset infections. Paediatric meningitis treatment of bacterial infection summary paediatric bacterial meningitis can be caused by a variety of different bacteria depending upon the age of the infected child. Choice and duration of antimicrobial therapy for neonatal. When doctors suspect neonatal meningitis, the newborn will have a lumbar puncture, or spinal tap, a procedure in which a needle is inserted in the back.
Clinical practice guideline summary clinical practice guidelines for the acute management of infants and children with bacterial meningitis. Lp is recommended before antibiotics for most cases. Data for the polish population indicate that the most common etiological factor for bm in neonates are escherichia coli and streptococcus agalactiae, while in infants neisseria meningitidis and streptococcus pneumoniae. The clinical status on the day of discharge from these. First, the introduction of conjugate vaccines in europe resulted in the virtual disappearance of. Empirical antibiotic therapy for early onset sepsis with penicillin or ampicillin and an aminoglycoside will treat meningitis due to group b streptococcus.
Neonatal bacterial meningitis most frequently results from the bacteremia that occurs with neonatal sepsis. Without treatment, the mortality rate from neonatal meningitis approaches 100%. Aggressive antimicrobial intervention is lifesaving in neonates with suspected meningitis. If dexamethasone is utilized for meningitis, then rifampin 1020 mgkgday, max 600 mgday should also.
The identification of neonates at risk for earlyonset sepsis is frequently based on a constellation of. He was born full term via normal spontaneous vaginal delivery. Group b streptococcus, enteric gram negatives in young infants. Meningitis is an infection of the meninges, the membrane covering the brain. Neonatal bacterial meningitis may also result from scalp lesions, particularly when developmental defects lead to communication between the skin surface and the subarachnoid space, which predisposes to. They noted the absence of clinical trials with third generation cephalosporins that. From january 2008 to june 2014, we enrolled 232 term neonates with bacterial meningitis admitted to 3 neonatology departments in shanghai, china. Neonatal meningitis is often caused by group b streptococcus and is associated with prematurity, gestational age, postnatal age, and geographic region. Despite advances in infant intensive care, neonatal meningitis remains a devastating disease. It is essential for clinicians to recognize the clinical signs and symptoms of meningitis and understand its management and prevention. With treatment, prognosis is determined by birth weight, organism, and clinical severity. Duration of treatment for bacterial meningitis is dependent on the clinical response and the organism causing disease.
By contrast, infants with disease caused by gramnegative enteric bacilli require a minimum. Management of bacterial meningitis in infants treatment for neonatal meningitis based on causative organism. Describe recent changes in the incidence and outcome of neonatal bacterial meningitis. When doctors suspect neonatal meningitis, the newborn will have a lumbar puncture, or spinal tap, a. Diagnosing and treating meningitis in babies in a neonatal unit this section is only about newborn babies who have suspected or confirmed meningitis who are in a neonatal unit. Neonatal meningitis, the facts this fact sheet provides information about the most common causes of neonatal meningitis and. The initial choice of antimicrobial agents for empirical treatment is dependent on the knowledge of the probable pathogens based on the perinatal history, including any maternal symptoms, cultures, or. With treatment, prognosis is determined by birthweight, organism, and clinical severity.
Bacterial meningitis is more common in the first month than at any other time of life 1. F173f178 twelve years ago an annotation was published in archives of disease in childhoodregarding the antibiotic treatment of suspected neonatal meningitis. If you have problems viewing pdf files, download the. Management of bacterial meningitis in infants meningitis in children and young people algorithm.
F1738 june 2003 with 1,4 reads how we measure reads. I o okike, c osullivan, n ninis, r lynn, c wright, p heath. For suspected bacterial meningitis in children 6 weeks old, consider. For neonatal meningitis caused by group b streptococci or l monocytogenes, 14 days of treatment are usually satisfactory. Patients with bacterial meningitis are usually treated by primary care and emergency medicine physicians at the time of initial presentation, often in consultation with infectious diseases specialists, neurologists, and neurosurgeons. Early recognition of neonates at risk of poor prognosis would be helpful in providing timely management. However, the developer chose to seek marketing approval for upper respiratory tract illness based on a 1day reduction in symptoms in adults with.
Mar 01, 2003 after completing this article, readers should be able to. It is known, however, that in many countries, agents with a broader spectrum, such as generation cephalosporinthird s, are commonly used to treat neonatal and infant sepsis. Prognosis has not improved in decades, despite the advent of improved antimicrobial therapy and heightened index of suspicion among clinicians caring for affected infants. Twelve years ago an annotation was published in archives of disease in childhood regarding the antibiotic treatment of suspected neonatal meningitis.