Neonatal Bacterial Meningitis

Pt < 1 m/o born at < 37 WGA with birthweight < 2,500 g to GBS+ mother presents with fever. Intrapartum complications included PPROM, chorioamnionitis, suboptimal APGAR scores. Parents report irritability, poor feeding. [Hypo/hyper]thermia, bulging fontanelle, nuchal rigidity exam.

  • Labs

    • Perform LP and send for analysis/culture

    • CSF demonstrates one of the following:

      • > 500 WBCs, > 80% neutrophils, protein > 50 g/L, glucose < 60

      • L. monocytogenes suspected due to CSF with > 100 WBCs, > 50% neutrophils, protein > 50 g/L, glucose < 60

  • Treatment

    • Start q 2 hour neurologic exams

    • Start ampicillin, gentamicin, cefotaxime (see notes)

      • Narrow antibiotics based on culture results

      • Repeat LP if no clinical improvement 24 to 48 hours after starting antibiotic therapy

  • Counseling

    • Parents advised that mortality rate is approximately 15%

    • Parents informed there is high risk for long-term neurologic impairment

Notes

  • Most common pathogens in neonates are Group B strep and E. Coli

  • Antibiotic dosing dependent upon weight and postnatal age