Diagnosis and treatment of bacterial meningitis in the newborn

Background: Bacterial meningitis in the newborn is globally renowned for high mortality. The associated morbidities also include audiologic, motor, visual and mental deficits. Objective: To highlight the peculiarities in the current diagnostic and management strategies in newborn meningitis. Methods: Relevant literature on the subject published only in English language or translated to English language was searched manually and electronically. The Medline, PUBMED and HINARI were searched for the period between 1966 and 2012. The following key words were used during the search: newborn/neonatal , bacter ial / pyogenic meningitis, central nervous system infections, antibiotics, dexamethasone and fluid restriction. Results: The pattern of bacterial aetiology and mortality differ between the developed and developing world. The usefulness of bacteriologic culture in the diagnosis of meningitis can be improved with serologic method like polymerase chain reaction. Widespread resistance of pathogens may be threatening the use of penicillins and gentamicin for empirical treatment of newborn meningitis. No sufficient evidence presently supports the current practices of fluid restriction, prolonged duration of antibiotic treatment and non-use of adjuvant steroid therapies in the newborn. Conclusion: Efforts to reduce the incidence of newborn meningitis cannot be separated from the prevention of newborn sepsis generally. In addition, more controlled trials are required in the developing world with respect to the various aspects of management of newborn meningitis, particularly fluid management and the use of adjuvant steroids.