Neonatal bacterial meningitis: an update

Meningitis is associated with significant mortality and morbidity in infants in the first 3 months of life. The most recent national surveillance study (1996–7) identified an overall mortality of 10% with 50% of cases having some form of disability at 5 year follow-up (24% serious); a risk of serious disability 16-fold higher than that of GP-matched controls. The mortality has declined over the last two decades but there has been no change in the long term morbidity. Despite this there have been no attempts to assess the quality of current diagnostic and management strategies. It seems likely that improved recognition, evaluation and treatment of bacterial meningitis in infants could lead to a reduction in mortality and morbidity. Similar analyses undertaken in the areas of paediatric meningococcal disease and adult meningitis have revealed deficiencies in healthcare delivery and suggested that these may play a part in adverse outcomes.This review will focus on the epidemiology, clinical features, diagnosis and management of neonatal meningitis including choice of antibiotics and the role of adjunctive therapies. We will also briefly review the mechanisms responsible for the brain injury that occurs so frequently.