pediatrics
Neonatal Bacterial Meningitis
Key Points
The most common causes of neonatal bacterial meningitis are group B streptococcus,E. coli, andL. monocytogenes. Manifestations are often nonspecific (eg, temperature instability, respiratory distress, jaundice, apnea). Although central nervous system signs (eg, lethargy, seizures, vomiting, irritability) may be present, classic findings such as a bulging or full fontanelle and nuchal rigidity are not common. Cerebrospinal fluid (CSF) culture is critical because some neonates with meningitis have normal CSF indices (eg, white blood cell count, protein and glucose levels). Begin empiric treatment withampicillin,gentamicin, andcefotaximefollowed by specific drugs based on the results of cultures and susceptibility testing. Corticosteroids are not used in neonatal meningitis. 