Late-Onset Meningitis in Sick, Very-Low-Birth-Weight Infants

Perlman, Jeffrey M.; Rollins, Nancy; Sánchez, Pablo J.

doi:10.1001/archpedi.1992.02160230055015

Cited by 18 publications

(8 citation statements)

References 17 publications

(2 reference statements)

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“…The major features are ventriculitis (including inflammation of the choroid plexus), vasculitis, cerebral edema, infarction, cortical neuronal necrosis, and periventricular leukomalacia; chronic pathologic features include hydrocephalus, multicystic encephalomalacia and porencephaly, and cerebral cortical and white matter atrophy [431]. Hydrocephalus may result from closure of the aqueduct or the foramina of the fourth ventricle by purulent exudate or by means of inflammatory impairment of CSF resorption through the arachnoid channels [344,432]. Because the fontanelles are open, exudative material can collect around the base of the brain without a significant increase in intracranial pressure.…”

Section: Pathologymentioning

confidence: 99%

“…Significant collections of purulent material can be present in the sulci and subarachnoid space, particularly around the basal cisterns, of infants with meningitis. Ventriculitis has been described in 20% to 90% of cases [23,344,432] and often is the reason for persistence of bacteria in CSF when obstruction ensues and for a slow clinical recovery [433]. Hydrocephalus may result from closure of the aqueduct or the foramina of the fourth ventricle by purulent exudate or by means of inflammatory impairment of CSF resorption through the arachnoid channels [344,432].…”

Section: Pathologymentioning

confidence: 99%

“…In addition to the physical findings observed in infants with meningitis, several investigators have reported the occurrence of fluid and electrolyte abnormalities associated with inappropriate antidiuretic hormone secretion, including hyponatremia, decreased urine output, and increased weight gain [432,438]. Occasionally, the onset of meningitis has been followed by a transient or persistent diabetes insipidus [477].…”

Section: Neurologic Signsmentioning

confidence: 99%

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Bacterial Sepsis and Meningitis

Nizet¹,

Klein²

2011

Infectious Diseases of the Fetus and Newborn

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Section: Pathologymentioning

confidence: 99%

Section: Pathologymentioning

confidence: 99%

Section: Neurologic Signsmentioning

confidence: 99%

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Bacterial Sepsis and Meningitis

Nizet¹,

Klein²

2011

Infectious Diseases of the Fetus and Newborn

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“…103 It is therefore useful to perform an ultrasound scan early in the course, when the infant' s condition is too critical for transport to the radiology department. Cranial ultrasonography is safe, convenient, and readily available; it can be done at the bedside and does not require sedation.…”

Section: Question 8: When Should Neuroimaging Be Considered and Whatmentioning

confidence: 99%

Neonatal Meningitis

Kaufman¹,

Zanelli²,

Cantey³

et al. 2012

Neurology: Neonatology Questions and Controversies

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“…Signs suggestive of meningeal irritation, including stiff neck, bulging fontanelle, convulsions, and opisthotonus, occur only in a minority of neonates with bacterial meningitis and cannot be relied on solely to identify such patients [1,3,5,19,20]. Other findings that can suggest meningitis include fluid and electrolyte abnormalities associated with inappropriate antidiuretic hormone secretion, with associated hyponatremia, decreased urine output, and weight gain [2,3]. Values that constitute a CSF pleocytosis or proteinosis vary depending on the gestational age of the neonate.…”

Section: Introductionmentioning

confidence: 99%

Meningitis in the neonate

Kimberlin

2002

Curr Treat Options Neurol

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Group B beta-hemolytic streptococci and Escherichia coli strains account for approximately two thirds of all cases of neonatal meningitis, while bacteria that typically account for meningitis in older age groups (Haemophilus influenzae type B, Neisseria meningitidis, and Streptococcus pneumoniae) are infrequent causes of meningitis in the neonatal population. As with other medical problems in neonates, signs and symptoms of bacterial infection of the central nervous system are generally few in number and nonspecific in nature. Manifestations that can suggest meningitis, as well as other serious illnesses, include temperature instability, lethargy, respiratory distress, poor feeding, vomiting, and diarrhea. Signs suggestive of meningeal irritation, including stiff neck, bulging fontanelle, convulsions, and opisthotonus, occur only in a minority of neonates with bacterial meningitis and cannot be relied on solely to identify such patients. Ampicillin and either gentamicin or cefotaxime are recommended for initial empiric therapy of neonatal meningitis. When the results of the cerebrospinal fluid (CSF) culture and susceptibilities are known, therapy can be narrowed to cover the specific pathogen identified. In general, penicillin G or ampicillin is preferred for group B streptococcal meningitis, ampicillin for Listeria monocytogenes meningitis, and ampicillin plus either an aminoglycoside or cefotaxime for gram-negative meningitis. For the very low birth weight neonate who has been in the nursery for a prolonged period of time, organisms such as enterococci and gentamicin-resistant gram-negative enteric bacilli must also be considered. In patients with long-term vascular catheters, Staphylococcus aureus or coagulase-negative staphylococci must also be considered. Empiric combinations of antibiotics for such patients would include ampicillin or vancomycin, plus amikacin or cefotaxime. All neonates should undergo repeat CSF examination and culture at 48 to 72 hours after initiation of therapy. If organisms are observed on gram stain, modification of the therapeutic regimen should be considered, and neuroimaging should be performed. In general, therapy should be continued for 14 to 21 days for neonatal meningitis caused by group B streptococci or L. monocytogenes, and for at least 21 days for disease caused by gram-negative enteric bacilli. All patients with neonatal meningitis should have hearing and development monitored serially. The first audiologic evaluation should occur 4 to 6 weeks after resolution of the meningitis.

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Late-Onset Meningitis in Sick, Very-Low-Birth-Weight Infants

Cited by 18 publications

References 17 publications

Bacterial Sepsis and Meningitis

Bacterial Sepsis and Meningitis

Neonatal Meningitis

Meningitis in the neonate

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