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Bacterial meningitis in the neonate: Neurologic complications

Morven S Edwards, MD
Carol J Baker, MD
Section Editors
Sheldon L Kaplan, MD
Leonard E Weisman, MD
Douglas R Nordli, Jr, 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 less than 10 to 15 percent [2-5]. However, the morbidity is relatively unchanged [6]. Among survivors of group B streptococcal meningitis, 22 percent were neurologically impaired at hospital discharge [7]. Survivors remain at high risk for neurologic sequelae and lifelong impairment as a result of infectious insult to their developing brains [3,5].

The neurologic complications of bacterial meningitis in the neonate will be discussed here. The clinical features, diagnosis, and treatment are discussed separately. (See "Bacterial meningitis in the neonate: Clinical features and diagnosis" and "Bacterial meningitis in the neonate: Treatment and outcome".)


Acute complications of neonatal bacterial meningitis include cerebral edema (vasogenic and cytotoxic), increased intracranial pressure, ventriculitis, cerebritis, hydrocephalus, brain abscess, cerebral infarction, and subdural effusion or empyema [8,9]. Development of these complications may necessitate additional evaluation, neurosurgical consultation, and/or lengthened duration of antimicrobial therapy.

Ventriculitis — Ventriculitis (inflammation of the ventricular fluid and lining of the ventricles, usually in association with obstruction to cerebrospinal fluid flow) is a common complication of neonatal meningitis [10,11]. In one series of gram-negative meningitis in 72 neonates, ventriculitis occurred in 20 percent (diagnosed either by ventricular tap or cranial computed tomography) [11].

There are no reliable clinical signs of ventriculitis, although evidence of increased intracranial pressure (ICP) usually is present [12]. It must be suspected on the basis of failure to respond clinically and bacteriologically to appropriate antimicrobial therapy; if ventriculitis results in obstruction to cerebrospinal fluid (CSF) flow, the access of systemic antibiotics to the ventricular CSF can be limited [9]. (See "Bacterial meningitis in the neonate: Treatment and outcome", section on 'Monitoring response to therapy'.)

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Literature review current through: Nov 2017. | This topic last updated: Dec 14, 2015.
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  1. Wenger JD, Hightower AW, Facklam RR, et al. Bacterial meningitis in the United States, 1986: report of a multistate surveillance study. The Bacterial Meningitis Study Group. J Infect Dis 1990; 162:1316.
  2. Harvey D, Holt DE, Bedford H. Bacterial meningitis in the newborn: a prospective study of mortality and morbidity. Semin Perinatol 1999; 23:218.
  3. 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. Bortolussi R, Krishnan C, Armstrong D, Tovichayathamrong P. Prognosis for survival in neonatal meningitis: clinical and pathologic review of 52 cases. Can Med Assoc J 1978; 118:165.
  5. Chang CJ, Chang WN, Huang LT, et al. Neonatal bacterial meningitis in southern Taiwan. Pediatr Neurol 2003; 29:288.
  6. Polin RA, Harris MC. Neonatal bacterial meningitis. Semin Neonatol 2001; 6:157.
  7. Levent F, Baker CJ, Rench MA, Edwards MS. Early outcomes of group B streptococcal meningitis in the 21st century. Pediatr Infect Dis J 2010; 29:1009.
  8. Renier D, Flandin C, Hirsch E, Hirsch JF. Brain abscesses in neonates. A study of 30 cases. J Neurosurg 1988; 69:877.
  9. Volpe JJ. Bacterial and fungal intracranial infections. In: Neurology of the newborn, 4th ed, WB Saunders Company, Philadelphia 2001. p.774.
  10. Salmon JH. Ventriculitis complicating meningitis. Am J Dis Child 1972; 124:35.
  11. Unhanand M, Mustafa MM, McCracken GH Jr, Nelson JD. Gram-negative enteric bacillary meningitis: a twenty-one-year experience. J Pediatr 1993; 122:15.
  12. Miyairi I, Causey KT, DeVincenzo JP, Buckingham SC. Group B streptococcal ventriculitis: a report of three cases and literature review. Pediatr Neurol 2006; 34:395.
  13. Yikilmaz A, Taylor GA. Sonographic findings in bacterial meningitis in neonates and young infants. Pediatr Radiol 2008; 38:129.
  14. Pong A, Bradley JS. Bacterial meningitis and the newborn infant. Infect Dis Clin North Am 1999; 13:711.
  15. McCracken GH Jr, Threlkeld N, Mize S, et al. Moxalactam therapy for neonatal meningitis due to gram-negative enteric bacilli. A prospective controlled evaluation. JAMA 1984; 252:1427.
  16. Berman PH, Banker BQ. Neonatal meningitis. A clinical and pathological study of 29 cases. Pediatrics 1966; 38:6.
  17. de Louvois J. Acute bacterial meningitis in the newborn. J Antimicrob Chemother 1994; 34 Suppl A:61.
  18. Kline MW, Kaplan SL. Citrobacter diversus and neonatal brain abscess. Pediatr Neurol 1987; 3:178.
  19. Graham DR, Band JD. Citrobacter diversus brain abscess and meningitis in neonates. JAMA 1981; 245:1923.
  20. Doran TI. The role of Citrobacter in clinical disease of children: review. Clin Infect Dis 1999; 28:384.
  21. Campbell JR, Diacovo T, Baker CJ. Serratia marcescens meningitis in neonates. Pediatr Infect Dis J 1992; 11:881.
  22. Phan H, Lehman D. Cerebral abscess complicating Proteus mirabilis meningitis in a newborn infant. J Child Neurol 2012; 27:405.
  23. Willis J, Robinson JE. Enterobacter sakazakii meningitis in neonates. Pediatr Infect Dis J 1988; 7:196.
  24. Iversen C, Lehner A, Mullane N, et al. Identification of "Cronobacter" spp. (Enterobacter sakazakii). J Clin Microbiol 2007; 45:3814.
  25. Biswas B, Mondal M, Thapa R, et al. Neonatal Brain Abscess due to Extended-Spectrum Beta-Lactamase Producing Klebsiella pneumoniae. J Clin Diagn Res 2014; 8:PD01.
  26. Hoffman HJ, Hendrick EB, Hiscox JL. Cerebral abscesses in early infancy. J Neurosurg 1970; 33:172.
  27. Nizet V, Klein JO. Bacterial sepsis and meningitis. In: Infectious Diseases of the Fetus and Newborn Infant, 8th ed, Remington JS, Klein JO, Wilson CB, et al (Eds), Elsevier Saunders, Philadelphia 2016. p.217.
  28. Rabe EF, Flynn RE, Dodge PR. Subdural collections of fluid in infants and children. A study of 62 patients with special reference to factors influencing prognosis and the efficacy of various forms of therapy. Neurology 1968; 18:559.
  29. Tibussek D, Sinclair A, Yau I, et al. Late-onset group B streptococcal meningitis has cerebrovascular complications. J Pediatr 2015; 166:1187.
  30. Friede RL. Cerebral infarcts complicating neonatal leptomeningitis. Acute and residual lesions. Acta Neuropathol 1973; 23:245.
  31. Hernández MI, Sandoval CC, Tapia JL, et al. Stroke patterns in neonatal group B streptococcal meningitis. Pediatr Neurol 2011; 44:282.
  32. Feigin RD, McCracken GH Jr, Klein JO. Diagnosis and management of meningitis. Pediatr Infect Dis J 1992; 11:785.
  33. Syrogiannopoulos GA, Nelson JD, McCracken GH Jr. Subdural collections of fluid in acute bacterial meningitis: a review of 136 cases. Pediatr Infect Dis 1986; 5:343.
  34. Libster R, Edwards KM, Levent F, et al. Long-term outcomes of group B streptococcal meningitis. Pediatrics 2012; 130:e8.
  35. de Goede CG, Jardine PE, Eunson P, et al. Severe progressive late onset myelopathy and arachnoiditis following neonatal meningitis. Eur J Paediatr Neurol 2006; 10:31.
  36. Soman TB, Moharir M, DeVeber G, Weiss S. Infantile spasms as an adverse outcome of neonatal cortical sinovenous thrombosis. J Child Neurol 2006; 21:126.