Meningitis

Learning objectives

After completion of this session the participant should be able to:

Suspect meningitis in an infant with sepsis or if they present with the clinical symptoms or signs of
meningitis: remember NYI often do not have neck stiffness.

Symptoms and signs

Investigations

  • To confirm the diagnosis of meningitis a lumbar puncture must be done immediately unless the young infant is convulsing actively or is unstable.
  • Blood culture
  • Urine microscopy and culture or a urine analysis

    • Empiric therapy for meningitis – how to calculate the dose, for doses see wall charts

    ANTIBIOTIC EACH DOSE FREQUENCY ROUTE
    Inj. Penicillin

    and

    Gentamicin    		 100,000iu/kg/dose <7 days: 12 hrly >7 days: 6 hrly IV
    LBW 3mg/kg/dose
    Term 5mg/kg/dose for first week
    Then 7.5mg/kg/dose thereafter    		 <7 days: 24 hrly >7 days: 24 hrly IV
    OR
    Inj. Ceftriaxone 100mg/kg/dose <7 days: 24 hrly >7 days: 24 hrly IV


    Key fact for providers - Supportive care for NYI with meningitis

    • Ensure warmth

    • Respiratory support with oxygen or CPAP if there is severe respiratory distress or apnoeas.
    • Gentle stimulation if apnoiec, consider aminophylline if premature and current age is estimated to be <37 weeks gestation.
    • If shocked treat according to impaired circulation protocol.
    • If hypoglycaemic, infuse 2mls/kg of 10% dextrose stat and recheck in 30 minutes, continue maintenance 10% dextrose.
    • If they have not received Vitamin K, give 1mg intramuscularly.
    • Treat convulsions if present.
    • Treat jaundice if present with phototherapy.
    • If very sick, e.g. continuous convulsions, avoid oral feeds, give maintenance IV fluids.

    Reassess therapy based on culture and antibiotic sensitivity results if feasible.

    Continue IV antibiotics for at least 2 weeks (e.g. GBS) or 3 weeks (Gram negative bacteria)

    If the organism is not known, but it is known the baby had meningitis then the safest duration is to give 3 weeks to cover for the possibility of gram negative bacteria causing the meningitis.

    Measure the NYI head circumference every 3 days as an intracranial abscess or hydrocephalus may develop. If circumference is increasing do ultrasound scan.