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Neonatal Meningitis: Can We Do Better?

Part of the Advances in Experimental Medicine and Biology book series (AEMB,volume 719)

Abstract

Bacterial meningitis is a serious disease worldwide. The greatest risk of acquiring meningitis is in the neonatal period. Neonatal meningitis is associated with significant mortality and, despite improvements in healthcare over the last two decades; severe neurological sequelae remain common and unchanged. There is an urgent need to identify interventions that may have an impact on clinical outcome. Here we discuss the epidemiology and the current management of neonatal bacterial meningitis with a view to identifying areas for future research.

Keywords

  • Lumbar Puncture
  • Bacterial Meningitis
  • Invasive Pneumococcal Disease
  • Neonatal Infection
  • Neck Flexion

These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. Goldacre MJ. Acute bacterial meningitis in childhood. Lancet. 1976;1:701.

    PubMed  CrossRef  CAS  Google Scholar 

  2. de Louvois J, Blackbourn J, Hurley R, Harvey D. Infantile meningitis in England and Wales: a two year study. Arch Dis Child. 1991;66:603–7.

    PubMed  CrossRef  Google Scholar 

  3. Hristeva L, Booy R, Bowler I, Wilkinson AR. Prospective surveillance of neonatal meningitis. Arch Dis Child. 1993;69:14–8.

    PubMed  CrossRef  CAS  Google Scholar 

  4. Holt DE, Halket S, de Louvois J, Harvey D. Neonatal meningitis in England and Wales: 10 years on. Arch Dis Child Fetal Neonatal Ed. 2001;84:F85–9.

    PubMed  CrossRef  CAS  Google Scholar 

  5. Goldacre MJ. Neonatal meningitis. Postgrad Med J. 1977;53:607–9.

    PubMed  CrossRef  CAS  Google Scholar 

  6. Persson E, Trollfors B, Brandberg LL, Tessin I. Septicaemia and meningitis in neonates and during early infancy in the Goteborg area of Sweden. Acta Paediatr. 2002;91:1087–92.

    PubMed  CrossRef  CAS  Google Scholar 

  7. Thaver D, Zaidi AK. Burden of neonatal infections in developing countries: a review of evidence from community-based studies. Pediatr Infect Dis J. 2009;28:S3–9.

    PubMed  CrossRef  Google Scholar 

  8. Synnott MB, Morse DL, Hall SM. Neonatal meningitis in England and Wales: a review of routine national data. Arch Dis Child. 1994;71:F75–80.

    PubMed  CAS  Google Scholar 

  9. Wenger JD, Hightower AW, Facklam RR, Gaventa S, Broome CV. Bacterial meningitis in the United States, 1986: report of a multistate surveillance study. The Bacterial Meningitis Study Group. J Infect Dis. 1990;162:1316–23.

    PubMed  CrossRef  CAS  Google Scholar 

  10. Francis BM, Gilbert GL. Survey of neonatal meningitis in Australia: 1987–1989. Med J Aust. 1992;156:240–3.

    PubMed  CAS  Google Scholar 

  11. Levy C, de La Rocque F, Cohen R. [Epidemiology of pediatric bacterial meningitis in France]. Med Mal Infect. 2009;39:419–31.

    PubMed  CrossRef  CAS  Google Scholar 

  12. Kalliola S, Vuopio-Varkila J, Takala AK, Eskola J. Neonatal group B streptococcal disease in Finland: a ten-year nationwide study. Pediatr Infect Dis J. 1999;18:806–10.

    PubMed  CrossRef  CAS  Google Scholar 

  13. Fluegge K, Siedler A, Heinrich B, Schulte-Moenting J, Moennig MJ, Bartels DB, et al. Incidence and clinical presentation of invasive neonatal group B streptococcal infections in Germany. Pediatrics. 2006;117:e1139–45.

    PubMed  CrossRef  Google Scholar 

  14. Neto MT. Group B streptococcal disease in Portuguese infants younger than 90 days. Arch Dis Child Fetal Neonatal Ed. 2008;93:F90–3.

    PubMed  CrossRef  CAS  Google Scholar 

  15. Heath PGT, Balfour G, Weisner AM, Efstratiou A, Lamagni TL, Tighe H, et al. Group B streptococcal disease in UK and Irish infants younger than 90 days. Lancet. 2004;363:292–4.

    PubMed  CrossRef  Google Scholar 

  16. Mulder CJ, Zanen HC. A study of 280 cases of neonatal meningitis in The Netherlands. J Infect. 1984;9:177–84.

    PubMed  CrossRef  CAS  Google Scholar 

  17. Franco SM, Cornelius VE, Andrews BF. Long-term outcome of neonatal meningitis. Am J Dis Child. 1992;146:567–71.

    PubMed  CAS  Google Scholar 

  18. Bedford H, de Louvois J, Halket S, Peckham C, Hurley R, Harvey D. Meningitis in infancy in England and Wales: follow up at age 5 years. BMJ. 2001;323:533–6.

    PubMed  CrossRef  CAS  Google Scholar 

  19. de Louvois J, Halket S, Harvey D. Neonatal meningitis in England and Wales: sequelae at 5 years of age. Eur J Pediatr. 2005;164:730–4.

    PubMed  CrossRef  Google Scholar 

  20. Stoll BJ, Hansen NI, Adams-Chapman I, Fanaroff AA, Hintz SR, Vohr B, et al. Neurodevelopmental and growth impairment among extremely low-birth-weight infants with neonatal infection. JAMA. 2004;292:2357–65.

    PubMed  CrossRef  CAS  Google Scholar 

  21. Palazzi D, Klein J, C B. Bacterial sepsis and meningitis. In: Remington JS, Klein J, editors. Infectious Disease of the Fetus and Newborn Infants 6th ed. Philadelphia: Elsevier Saunders; 2006. p. 247–95.

    CrossRef  Google Scholar 

  22. Thompson MJ, Ninis N, Perera R, Mayon-White R, Phillips C, Bailey L, et al. Clinical recognition of meningococcal disease in children and adolescents. Lancet. 2006;367:397–403.

    PubMed  CrossRef  Google Scholar 

  23. Holt DE. Neonatal meningitis in England and Wales: 10 years on. Archives of Disease in Childhood - Fetal and Neonatal Edition. 2001;84:85 F-9.

    CrossRef  Google Scholar 

  24. May M. Early onset neonatal meningitis in Australia and New Zealand, 1992–2002. Archives of Disease in Childhood - Fetal and Neonatal Edition. 2005;90:F324-f7.

    PubMed  CrossRef  CAS  Google Scholar 

  25. Heath PT, Balfour GF, Tighe H, Verlander NQ, Lamagni TL, Efstratiou A. Group B streptococcal disease in infants: a case control study. Archives of Disease in Childhood. 2009;94:674–80.

    PubMed  CrossRef  CAS  Google Scholar 

  26. Merenstein GB. Neonatal sepsis. Current Opinion in Infectious Diseases. 1992;5:553–7.

    CrossRef  Google Scholar 

  27. Johnson CE, Whitwell JK, Pethe K, Saxena K, Super DM. Term newborns who are at risk for sepsis: are lumbar punctures necessary? Pediatrics. 1997;99:E10.

    PubMed  CrossRef  CAS  Google Scholar 

  28. Fielkow S, Reuter S, Gotoff SP. Cerebrospinal fluid examination in symptom-free infants with risk factors for infection. J Pediatr. 1991;119:971–3.

    PubMed  CrossRef  CAS  Google Scholar 

  29. Wiswell TE, Baumgart S, Gannon CM, Spitzer AR. No lumbar puncture in the evaluation for early neonatal sepsis: will meningitis be missed? Pediatrics. 1995;95:803–6.

    PubMed  CAS  Google Scholar 

  30. Visser VE, Hall RT. Lumbar puncture in the evaluation of suspected neonatal sepsis. J Pediatr. 1980;96:1063–7.

    PubMed  CrossRef  CAS  Google Scholar 

  31. Garges HP. Neonatal Meningitis: What Is the Correlation Among Cerebrospinal Fluid Cultures, Blood Cultures, and Cerebrospinal Fluid Parameters? Pediatrics. 2006;117:1094–100.

    PubMed  CrossRef  Google Scholar 

  32. Ansong AK, Smith PB, Benjamin DK, Clark RH, Li JS, Cotten CM, et al. Group B streptococcal meningitis: cerebrospinal fluid parameters in the era of intrapartum antibiotic prophylaxis. Early Hum Dev. 2009;85:S5–7.

    PubMed  CrossRef  Google Scholar 

  33. Vergnano S, Embleton N, Collinson A, Menson E, Russell BA, Heath P. Missed opportunities for preventing group B streptococcus infection. Archives of Disease in Childhood - Fetal and Neonatal Edition 2009;95:F72–F3.

    PubMed  CrossRef  Google Scholar 

  34. Kestenbaum LA, Ebberson J, Zorc JJ, Hodinka RL, Shah SS. Defining Cerebrospinal Fluid White Blood Cell Count Reference Values in Neonates and Young Infants. Pediatrics. 2010;125:257–64.

    PubMed  CrossRef  Google Scholar 

  35. Sarman G, Moise AA, Edwards MS. Meningeal inflammation in neonatal gram-negative bacteremia. Pediatr Infect Dis J. 1995;14:701–4.

    PubMed  CrossRef  CAS  Google Scholar 

  36. Nigrovic LE, Malley R, Macias CG, Kanegaye JT, Moro-Sutherland DM, Schremmer RD, et al. Effect of Antibiotic Pretreatment on Cerebrospinal Fluid Profiles of Children With Bacterial Meningitis. Pediatrics. 2008;122:726–30.

    PubMed  CrossRef  Google Scholar 

  37. Chiba N, Murayama SY, Morozumi M, Nakayama E, Okada T, Iwata S, et al. Rapid detection of eight causative pathogens for the diagnosis of bacterial meningitis by real-time PCR. Journal of Infection and Chemotherapy. 2009;15:92–8.

    PubMed  CrossRef  CAS  Google Scholar 

  38. Rajesh NT, Dutta S, Prasad R, Narang A. Effect of delay in analysis on neonatal cerebrospinal fluid parameters. Archives of Disease in Childhood - Fetal and Neonatal Edition. 2009;95:F25–F9.

    PubMed  CrossRef  Google Scholar 

  39. Abo A, Chen L, Johnston P, Santucci K. Positioning for Lumbar Puncture in Children Evaluated by Bedside Ultrasound. Pediatrics. 2010;125:e1149–e53.

    PubMed  CrossRef  Google Scholar 

  40. Heath PT. Neonatal meningitis. Archives of Disease in Childhood - Fetal and Neonatal Edition. 2003;88:173 F–8.

    CrossRef  Google Scholar 

  41. Millar M, Philpott A, Wilks M, Whiley A, Warwick S, Hennessy E, et al. Colonization and persistence of ­antibiotic-resistant Enterobacteriaceae strains in infants nursed in two neonatal intensive care units in East London, United Kingdom. J Clin Microbiol. 2008;46:560–7.

    PubMed  CrossRef  CAS  Google Scholar 

  42. Tiskumara R, Fakharee SH, Liu CQ, Nuntnarumit P, Lui KM, Hammoud M, et al. Neonatal infections in Asia. Archives of Disease in Childhood - Fetal and Neonatal Edition. 2009;94:F144–F8.

    PubMed  CrossRef  CAS  Google Scholar 

  43. Mitja O, Pigrau C, Ruiz I, Vidal X, Almirante B, Planes AM, et al. Predictors of mortality and impact of aminoglycosides on outcome in listeriosis in a retrospective cohort study. J Antimicrob Chemother. 2009;64:416–23.

    PubMed  CrossRef  CAS  Google Scholar 

  44. Klinger G, Chin CN, Beyene J, Perlman M. Predicting the outcome of neonatal bacterial meningitis. Pediatrics. 2000;106:477–82.

    PubMed  CrossRef  CAS  Google Scholar 

  45. Fernando AM, Heath PT, Menson EN. Antimicrobial policies in the neonatal units of the United Kingdom and Republic of Ireland. J Antimicrob Chemother. 2008;61:743–5.

    PubMed  CrossRef  CAS  Google Scholar 

  46. Rivers E, Nguyen B, Havstad S, Ressler J, Muzzin A, Knoblich B, et al. Early goal-directed therapy in the ­treatment of severe sepsis and septic shock. N Engl J Med. 2001;345:1368–77.

    PubMed  CrossRef  CAS  Google Scholar 

  47. Carcillo JA, Davis AL, Zaritsky A. Role of early fluid resuscitation in pediatric septic shock. JAMA. 1991;266:1242–5.

    PubMed  CrossRef  CAS  Google Scholar 

  48. Han YY, Carcillo JA, Dragotta MA, Bills DM, Watson RS, Westerman ME, et al. Early reversal of pediatric-neonatal septic shock by community physicians is associated with improved outcome. Pediatrics. 2003;112:793–9.

    PubMed  CrossRef  Google Scholar 

  49. Nau R, Wellmer A, Soto A, Koch K, Schneider O, Schmidt H, et al. Rifampin reduces early mortality in experimental Streptococcus pneumoniae meningitis. J Infect Dis. 1999;179:1557–60.

    PubMed  CrossRef  CAS  Google Scholar 

  50. Grandgirard D, Oberson K, Buhlmann A, Gaumann R, Leib SL. Attenuation of cerebrospinal fluid inflammation by the nonbacteriolytic antibiotic daptomycin versus that by ceftriaxone in experimental pneumococcal meningitis. Antimicrob Agents Chemother. 2010;54:1323–6.

    PubMed  CrossRef  CAS  Google Scholar 

  51. McCracken GH, Jr., Mize SG. A controlled study of intrathecal antibiotic therapy in gram-negative enteric ­meningitis of infancy. Report of the neonatal meningitis cooperative study group. J Pediatr. 1976;89:66–72.

    PubMed  CrossRef  Google Scholar 

  52. McCracken GH, Jr., Mize SG, Threlkeld N. Intraventricular gentamicin therapy in gram-negative bacillary meningitis of infancy. Report of the Second Neonatal Meningitis Cooperative Study Group. Lancet. 1980;1:787–91.

    PubMed  Google Scholar 

  53. Ohlsson A, Lacy JB. Intravenous immunoglobulin for suspected or subsequently proven infection in neonates. Cochrane Database Syst Rev. 2004:CD001239.

    Google Scholar 

  54. (http://www.npeu.ox.ac.uk/inis).

  55. Bedford Russell AR, Emmerson AJ, Wilkinson N, Chant T, Sweet DG, Halliday HL, et al. A trial of recombinant human granulocyte colony stimulating factor for the treatment of very low birthweight infants with presumed sepsis and neutropenia. Arch Dis Child Fetal Neonatal Ed. 2001;84:F172–6.

    PubMed  CrossRef  CAS  Google Scholar 

  56. Carr R, Brocklehurst P, Dore CJ, Modi N. Granulocyte-macrophage colony stimulating factor administered as prophylaxis for reduction of sepsis in extremely preterm, small for gestational age neonates (the PROGRAMS trial): a single-blind, multicentre, randomised controlled trial. Lancet. 2009;373:226–33.

    PubMed  CrossRef  CAS  Google Scholar 

  57. Yu JS, Grauaug A. Purulent Meningitis in the Neonatal Period. Arch Dis Child. 1963;38:391–6.

    PubMed  CrossRef  CAS  Google Scholar 

  58. Daoud AS, Batieha A, Al-Sheyyab M, Abuekteish F, Obeidat A, Mahafza T. Lack of effectiveness of dexamethasone in neonatal bacterial meningitis. Eur J Pediatr. 1999;158:230–3.

    PubMed  CrossRef  CAS  Google Scholar 

  59. Peltola H, Roine I, Fernandez J, Zavala I, Ayala SG, Mata AG, et al. Adjuvant glycerol and/or dexamethasone to improve the outcomes of childhood bacterial meningitis: a prospective, randomized, double-blind, placebo-­controlled trial. Clin Infect Dis. 2007;45:1277–86.

    PubMed  CrossRef  CAS  Google Scholar 

  60. Baker CJ, Rench MA, McInnes P. Immunization of pregnant women with group B streptococcal type III capsular polysaccharide-tetanus toxoid conjugate vaccine. Vaccine. 2003;21:3468–72.

    PubMed  CrossRef  CAS  Google Scholar 

  61. Law MR, Palomaki G, Alfirevic Z, Gilbert R, Heath P, McCartney C, et al. The prevention of neonatal group B streptococcal disease: a report by a working group of the Medical Screening Society. J Med Screen. 2005;12:60–8.

    PubMed  CrossRef  CAS  Google Scholar 

  62. Poehling KA, Talbot TR, Griffin MR, Craig AS, Whitney CG, Zell E, et al. Invasive pneumococcal disease among infants before and after introduction of pneumococcal conjugate vaccine. JAMA. 2006;295:1668–74.

    PubMed  CrossRef  CAS  Google Scholar 

  63. Slack M, et al. The 7th International Symposium on Pneumococci and Pneumococcal Diseases. Tel Aviv Israel 2010.

    Google Scholar 

  64. Sarff LD, Platt LH, McCracken GH, Jr. Cerebrospinal fluid evaluation in neonates: comparison of high-risk infants with and without meningitis. J Pediatr. 1976;88:473–7.

    PubMed  CrossRef  CAS  Google Scholar 

  65. Portnoy JM, Olson LC. Normal cerebrospinal fluid values in children: another look. Pediatrics. 1985;75:484–7.

    PubMed  CAS  Google Scholar 

  66. Bonadio WA, Stanco L, Bruce R, Barry D, Smith D. Reference values of normal cerebrospinal fluid composition in infants ages 0 to 8 weeks. Pediatr Infect Dis J. 1992;11:589–91.

    PubMed  CAS  Google Scholar 

  67. Ahmed A, Hickey SM, Ehrett S, Trujillo M, Brito F, Goto C, et al. Cerebrospinal fluid values in the term neonate. Pediatr Infect Dis J. 1996;15:298–303.

    PubMed  CrossRef  CAS  Google Scholar 

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Heath, P.T., Okike, I.O., Oeser, C. (2012). Neonatal Meningitis: Can We Do Better?. In: Curtis, N., Finn, A., Pollard, A. (eds) Hot Topics in Infection and Immunity in Children VIII. Advances in Experimental Medicine and Biology, vol 719. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-0204-6_2

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