Neonatal Meningitis

Posted by e-Medical PPT
Neonates are at greater risk of sepsis and meningitis than other age groups because of deficiencies in humoral and cellular immunity and in phagocytic function.Despite development of effective vaccines, tools for rapid identification of pathogens, and potent antimicrobial drugs, neonatal meningitis continues to contribute substantially to neurological disability worldwide. The persistence of neonatal meningitis results from increasing numbers of infants surviving premature delivery and from limited access to medical resources in developing countries.Regardless of the specific pathogen involved, neonatal meningitis is most often caused by vertical transmission during labor and delivery. It occurs most frequently in the days following birth and is more common in premature infants than term infants.
Risk factors for the development of meningitis include low birth weight (<2500 g), preterm birth (<37 weeks' gestation), premature rupture of membranes, traumatic delivery, fetal hypoxia, and maternal peripartum infection (including chorioamnionitis).
Early onset bacterial meningitis,
    * Symptoms appearing in the first 48 hours of life are referable primarily to systemic illness rather than meningitis. These include temperature instability, episodes of apnea or bradycardia, hypotension, feeding difficulty, hepatic dysfunction, and irritability alternating with lethargy.
Late onset bacterial meningitis,
    * Late-onset bacterial meningitis (symptom onset beyond 48 hours of life) is more likely to be associated with neurologic symptoms.Between 25% and 50% of neonates will exhibit the following neurological signs: seizures; bulging anterior fontanel; extensor posturing/ opisthotonus; focal cerebral signs including gaze deviation and hemiparesis; cranial nerve palsies. Nuchal rigidity per se is the least common neurologic sign in neonatal bacterial meningitis.

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