NEONATAL MENINGITIS

Abstract

The case histories of 29 infants in whom purulent meningitis developed during the first month of life were reviewed. There was a high incidence of maternal perinatal infections, and identical organisms were frequently isolated from both the mother and offspring. Gram-negative intestinal organisms were the most frequent etiologic agents. Because signs suggesting meningeal and nervous system involvement developed only late in the course of the illness, the diagnosis was frequently not made until the spinal fluid was examined. The course of the illness was usually fulminant; death occurred within 4 days from the onset of symptoms in the majority of infants. Of the five infants who recovered from the meningitis, four died from neurologic complications within a few months. Postmortem examinations were performed on 25 infants. Although the inflammatory reaction was essentially limited to the spinal fluid pathways and their contents, a wide-spread, at times devastating, non-infectious encephalopathy occurred in every case. Our observations emphasize the paucity and subtlety of the clinical manifestations of meningitis in the neonate and the remarkably high mortality that seems to be little influenced by standard methods of therapy. The pathological features of a meningitis in the newborn are similar to those in the more mature individuals, except for the sparsity of lymphocytes in the subacute stage of the meningeal reaction, the prominence of bacteria in the meningeal exudate long after appropriate antibiotics have been employed, and the high frequency of sequelae in the survivors. The sparsity and delay in appearance of lymphocytes and plasma cells in the inflammatory response may be an important factor in the inadequate defense of the newborn to this infection.