Neonatal meningitis, the facts This fact sheet provides information about the most common causes of neonatal meningitis Key points and answers some frequently asked questions. This should be read in addition to our ‘Meningitis • Neonatal meningitis occurs in the can affect anyone’ leaflet which provides more information on signs and symptoms and first 28 days of life emergency action to take. Information about • Many different organisms can cause other types of meningitis that can affect newborn neonatal meningitis and very young babies can be found on our other There are approximately 350 cases fact sheets. All our information can be found at • www.MeningitisNow.org. You can also request of neonatal bacterial meningitis each any of our information materials by contacting our year in the UK Meningitis Helpline on 0808 80 10 388. • Urgent treatment with antibiotics is vital Words highlighted in blue are explained in a glossary on the back page. Meningitis is inflammation of the membranes E. coli are common bacteria found in the large that surround the brain and spinal cord. These intestine of nearly all healthy people and, like membranes are called the meninges – they help GBS, may be passed to a baby during delivery. protect the brain from injury and infection. Although most strains of E. coli do not cause disease, serious infections may occur if the Septicaemia** is a severe infection of the blood. bacteria invade areas of the body in which they Bacteria multiply in the blood, releasing toxins are not normally found, such as the urinary tract, that cause widespread damage to the body. blood stream, or meninges. Another rare cause of neonatal meningitis is What is neonatal meningitis? Listeria monocytogenes. Generally acquired as a food-borne infection, these bacteria may cause Neonatal meningitis is the term used to describe a flu-like illness with diarrhoea in a pregnant meningitis that occurs in the first 28 days of life. woman, but may also be passed to the baby in Many different organisms can cause neonatal the womb across the placenta. Infection may meningitis, broadly grouped as bacteria, viruses cause premature labour, and the baby will usually and fungi. However, the most common causes be unwell from the time of birth, although late are bacteria; in particular group B streptococcus onset disease is also recognised. (GBS) and Escherichia coli (E. coli). Very few cases of Listeria meningitis now GBS bacteria live harmlessly in the vagina occur each year in the UK. This is as a result and intestinal tract of approximately 20–40% of successful education campaigns warning of women. These bacteria can sometimes be about the dangers of eating unpasteurised soft passed to the baby during delivery. The result cheeses, pâté and other foods that might harbour is usually colonisation of the skin surfaces Listeria bacteria during pregnancy. and only a small percentage of babies go on to GBS, E. coli and Listeria bacteria can cause both become ill with serious infection. When a baby meningitis and septicaemia, which can either becomes ill in the first six days of life this is called occur separately or together. early onset disease. When a baby becomes ill between seven and 28 days after birth this is called late onset disease. Rarely, infection may septicaemia** many medical experts now use the term occur as late as three months of age. sepsis instead of septicaemia. Meningitis Helpline 0808 80 10 388 (UK) www.MeningitisNow.org 1 Can neonatal meningitis be prevented? The meninges then become inflamed, increasing pressure around the brain which can cause nerve Currently there are no vaccines available to damage and specific symptoms associated with protect against group B streptococcus, E. coli or meningitis. Listeria infections. Infection in the bloodstream can itself be life- There are many factors affecting whether or not threatening. As the bacteria multiply, they a newborn develops meningitis. Adopting good begin to release toxins. The body’s natural hygiene practices is important as this may help to defences have little effect on these poisons. As reduce the risk of neonatal meningitis. septicaemia advances, it affects the whole body and can cause organ damage or failure. In the UK there is no national screening programme to routinely check all pregnant The signs and symptoms of meningitis or women to see if they carry GBS bacteria in their septicaemia are often non-specific at first and vagina in pregnancy. However, a risk based can be difficult to recognise in very young babies. strategy is widely used and antibiotics, known as Therefore it is important to trust your instincts ‘intrapartum antibiotic prophylaxis’ (IAP), may be as a parent/carer and seek medical attention offered during labour/delivery to women who are urgently if you suspect your child is ill. Some considered ‘at risk’. All pregnant women should common signs and symptoms are listed below. be provided with an information leaflet about They can appear in any order and some may not GBS infection during pregnancy. appear at all. There are factors which may increase the risk of • Fever (with cold hands and feet)* having a baby with GBS and a pregnant woman • Reluctance to feed is considered to be ‘at risk’ if: • Vomiting and/or diarrhoea • Irritability/dislike being handled • during pregnancy GBS bacteria have been found in the urine, or on a swab from the • Floppy/difficult to wake/unresponsive vagina and/or rectum taken for some other • Difficulties breathing or grunting reason • Faster or slower than normal breathing rate she has previously had a baby with GBS • Pale/blotchy skin infection • Red/purple spots/rash that do not fade under labour starts, or the waters break before 37 • • pressure completed weeks of pregnancy • High pitched cry/moaning/whimpering • she has a high temperature during labour or there are other signs of suspected maternal • Bulging fontanelle (soft spot) infection • Convulsions/seizures • the time between the waters breaking and • Arched back delivery of the baby is prolonged • Swollen abdomen There is national guidance for maternity staff on • Dry nappies how to manage women in these groups and their * Be aware that some young babies may have a babies. Any baby born to an ‘at risk’ mother will be closely monitored for signs of infection. normal or low temperature How does a baby develop meningitis? How is neonatal meningitis treated? Occasionally, bacteria overcome the body’s In hospital, various tests can be carried out to establish the type of meningitis and treatment defences and cause infection. In this process the is started accordingly. One of the main bacteria may spread through the bloodstream to investigations carried out to test if a baby has the meninges and cause meningitis. When the meningitis is a lumbar puncture. This allows the bacteria infect the meninges, tiny blood vessels doctor to quickly make a diagnosis of meningitis in the membranes are damaged. This allows by analysing the CSF that bathes the meninges. the bacteria to break through and infect the This fluid becomes infected when a baby has cerebrospinal fluid (CSF). meningitis. 2 3 Urgent treatment with antibiotics is vital. In babies who have experienced meningitis at Sometimes treatment with antibiotics is started a very young age, some after-effects, including because the baby’s condition is too serious for a learning difficulties and behavioural problems, lumbar puncture to be performed. In these cases may not be apparent at the time of illness. It is the lumbar puncture can be done when the baby’s important that these babies have regular follow- condition has improved or stabilised. The duration up and developmental assessments. of antibiotic treatment will vary depending on the type of bacteria that has caused the meningitis. A booklet ‘Your guide’ provides more information about the after-effects of If a baby is seriously ill, specialist care in an bacterial meningitis and meningococcal intensive care unit will be required. Here the septicaemia in children. To request a copy doctors and nurses can closely monitor the baby’s condition, respond to emergencies and provide or find out more about after-effects and the immediate support when it is needed. Appropriate support Meningitis Now can offer, go to hospital care and treatment are essential if the www.MeningitisNow.org or call our helpline. baby is to make a good recovery. This booklet can also be downloaded at What happens when there is a case? www.MeningitisNow.org/recovery Cases of neonatal meningitis caused by GBS, E. Tragically some babies will die, despite receiving coli and Listeria are reportable to public health, but the best possible treatment and care. The death are not considered to be contagious. Therefore, of a baby following meningitis or septicaemia can close contact with a baby who has the illness poses be traumatic, distressing and painful. If your baby no increased risk of infection. There is little chance has died following meningitis or septicaemia, our of a second related case occurring. If meningitis helpline staff are there to listen, and can explain and septicaemia are caused by other bacteria, the different ways we are able to offer help and the public health team may need to take action by support. tracing close contacts to reduce the slight risk of further, related cases. Find out more What happens after neonatal meningitis? • Meningitis Now Many babies will make a good recovery. However, www.MeningitisNow.org up to 50% of babies who have neonatal meningitis Information about meningitis and the work of may be left with after-effects. Meningitis Now. The after-effects of meningitis usually happen • NHS immunisation information because of damage to various areas of the brain, www.nhs.uk/conditions/vaccinations/ including the nerves responsible for hearing and Information about vaccines and NHS sight.