Meningitis in NYI (Chapter 17)

Learning Objectives

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

See supportive care care of meningitis
See investigations in case of suspicion of meningitis

Definition of Meningitis

Meningitis is inflammation of the meninges.

Symptoms and Signs

Suspect meningitis in an infant with sepsis or if they present with the following clinical symptoms or signs:

Note: NYI often do not have neck stiffness

Investigations

To confirm the diagnosis of meningitis, a lumbar puncture must be done immediately unless the young infant is convulsing actively or is unstable.

Also a blood culture, urine dipstick, microscopy and culture if available or a urine analysis.

Empiric therapy for meningitis: How to calculate the dose
For doses see wall charts

ANTIBIOTIC EACH DOSE FREQUENCY ROUTE
Age <7 days Age >7 days
Benzyl
penicillin		 100,000 IU/kg 12 hrly. 6 hrly. IV
AND
Gentamicin LBW 3 mg/kg/dose
Term 5 mg/kg/dose for 1st week
>7 days 7,5 mg/kg/dose 		24 hrly. 24 hrly. IV
OR
Ceftriaxone 100 mg/kg/dose 24 hrly. 24 hrly. IV

Key Facts for Providers:
Supportive Care for NYI with Meningitis
  • Ensure warmth.
  • Respiratory support with oxygen or CPAP if there is severe respiratory distress or apnoea.
  • Gentle stimulation if apnoeic, consider aminophylline if premature and current age is estimated to be <37 weeks gestation.
  • If shocked treat according to the impaired circulation protocol.
  • If hypoglycaemic, infuse 2mls/kg of 10% dextrose stat and recheck in 30 minutes, continue maintenance 10% dextrose.
  • Treat convulsions if present
  • Treat jaundice if present with phototherapy
  • If very sick, e.g., continuous convulsions, avoid oral feeds, give maintenance fluids.
  • If they have not received Vitamin K, give 1mg to term baby or 0.5 mg to premature babies intramuscularly.
  • Reassess therapy based on culture and antibiotic sensitivity results if possible.
  • Continue IV antibiotics for at least 2 weeks (e.g., for GBS) or 3 weeks (for Gram negative bacteria).
  • If the organism is not known, but it is known that the baby has meningitis, then the safest duration to give antibiotics is for 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 a cranial ultrasound scan.