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Bacterial meningitis in the neonate: Clinical features and diagnosis

Morven S Edwards, MD
Carol J Baker, MD
Section Editors
Sheldon L Kaplan, MD
Leonard E Weisman, MD
Deputy Editor
Carrie Armsby, MD, MPH


Bacterial meningitis is more common in the first month than at any other time of life [1]. Despite advances in infant intensive care, neonatal meningitis remains a devastating disease.

The mortality rate declined from almost 50 percent in the 1970s to contemporary rates of 10 to 15 percent [2-6]. However, during the same time period, the morbidity rate was relatively unchanged [6]. Survivors remain at high risk for neurologic sequelae and lifelong impairment as a result of infectious insult to their developing brains [3,7].

The epidemiology, etiology, clinical features, and diagnosis of bacterial meningitis in the neonate will be discussed here. The treatment, prognosis, and complications of neonatal bacterial meningitis are discussed separately, as is bacterial meningitis in older children. (See "Bacterial meningitis in the neonate: Treatment and outcome" and "Bacterial meningitis in the neonate: Neurologic complications" and "Bacterial meningitis in children older than one month: Clinical features and diagnosis" and "Bacterial meningitis in children older than one month: Treatment and prognosis" and "Bacterial meningitis in children: Neurologic complications".)


The documented incidence of bacterial meningitis in neonates (infants <1 month) has declined substantially since the 1970s largely due to prevention of early-onset group B streptococcal (GBS) meningitis through maternal screening and intrapartum antibiotic prophylaxis and prompt evaluation of infants in neonatal intensive care units (NICUs) [8]. Depending upon the inclusion criteria, the incidence is between 0.25 and 0.32 per 1000 live births [9-11]. Although specific data to document this are lacking, it is our impression that bacterial meningitis in the neonate is encountered rarely in clinical practice.

Bacterial meningitis occurs in as many as 15 percent of neonates with bacteremia. Among infants with invasive GBS disease, 5 to 10 percent with early-onset and approximately 25 percent of those with late-onset infections have meningitis [12,13]. Risk factors for neonatal sepsis and meningitis include low birth weight (LBW, <2500 g), preterm birth (<37 weeks' gestation) [14,15], premature rupture of membranes (ie, before the onset of labor or regular uterine contractions) [16], septic or traumatic delivery [16,17], fetal hypoxia, maternal peripartum infection [17], galactosemia [18,19], and urinary tract abnormalities [20].


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Literature review current through: Sep 2016. | This topic last updated: Jan 18, 2016.
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