PROSPECTIVE SURVEILLANCE OF NEONATAL MENINGITIS

Neonatal meningitis is a serious problem with a high mortality and fre quent neurological sequelae. The incidence of neonatal meningitis was calculated and the aetiology, clinical and laboratory features, and th e treatment of cases recorded prospectively over a 7 year 8 month peri od was documented. It was further investigated whether secondary menin gitis had occurred after lumbar puncture. The estimated incidence of b acterial, viral, and fungal meningitis was 0.25, 0.11, and 0.02 per 10 00 live births respectively. There were eight cases of early onset men ingitis (seven definite, one probable) and group B streptococci accoun ted for six (75%) of these. Blood cultures were negative in only one o f seven cases of definite early bacterial meningitis. Of the IS late o nset cases, Gram negative organisms accounted for six of the seven bac terial cases. The overall mortality was 26%. Of the 11 survivors of ba cterial meningitis, three (27%) had significant neurological sequelae at follow up (between three months to three years later). As in the fi rst 48 hours after birth an initial blood culture is unlikely to be ne gative if bacterial meningitis is present, lumbar puncture can be defe rred if the procedure might exacerbate respiratory distress. Although approximately 1880 infants had a lumbar puncture during the review per iod, only one case of meningitis was found where it was possible that lumbar puncture in a bacteraemic infant may have caused meningeal infe ction. The incidence of this potential complication must therefore be low.