After completion of this session the participant should be able to:
- Describe how a NYI with meningitis may present
- Describe the management of a NYI with meningitis
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
- Drowsy, lethargy or unconscious
- Persistent irritability
- High pitched cry
- Apnoiec episodes
- Bulging fontanelle
To confirm the diagnosis of meningitis a lumbar puncture must be done immediately unless the young infant is convulsing actively or is unstable.
Urine microscopy and culture or a urine analysis
Empiric therapy for meningitis – how to calculate the dose, for doses see wall charts
||<7 days: 12 hrly
||>7 days: 6 hrly
Term 5mg/kg/dose for first week
Then 7.5mg/kg/dose thereafter
|<7 days: 24 hrly
||>7 days: 24 hrly
| Inj. Ceftriaxone
||<7 days: 24 hrly
||>7 days: 24 hrly
Key fact for providers - Supportive care for NYI with meningitis
- 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
Measure the NYI head circumference every 3 days as an intracranial abscess or
hydrocephalus may develop. If circumference is increasing do ultrasound scan.