Neonatal meningitis

Introduction
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By Karen L Roos MD

The clinical presentation of neonatal meningitis is nonspecific and the spinal fluid abnormalities may be difficult to differentiate from normal values in the newborn. Meningitis should be suspected in a newborn with either irritability and fever or hypothermia, or seizure, and a CSF white blood cell count that is greater than 30 cells/mm3 in association with a CSF:serum glucose ratio that is less than 0.5. Empiric antimicrobial therapy includes a combination of ampicillin and a third- or fourth-generation cephalosporin. Although adjunctive dexamethasone therapy is recommended in children and adults, there is insufficient evidence to date to recommend dexamethasone therapy for neonatal meningitis.