Diagnostic dilemmas in neonatal meningitis

Česká verzia

Authors: K. Maťašová Jr.; L. Časnocha Lúčanová; M. Zibolen
Authors place of work: Neonatologická klinika, Jesseniova lekárska fakulta UK a Univerzitná nemocnica, Martin
Published in the journal: Čes-slov Neonat 2023; 29 (1): 42-50.
Category: Reviews

Summary

Meningitis is a relatively common disease in the neonatal period and in addition to acute complications it can have a negative impact on further neurodevelopment. Early diagnosis and adequate treatment are necessary to improve prognosis and reduce morbidity and mortality. Establishing the diagnosis is complicated due to non-specific clinical manifestation, ambiguous interpretation of inflammatory parameters, as well as findings in cerebrospinal fluid. Despite the fact that examination of cerebrospinal fluid is standard in the diagnosis of meningitis, lumbar puncture is often not performed on time and the interpretation of the results of cerebrospinal fluid analysis can be influenced by various factors, for example by gestational age, previous antibiotic treatment or artificial admixture of blood in the sample. The prone position of the baby during lumbar puncture increases the success of the procedure and the comfort of the child and reduces the need for administration of analgesics before the procedure. An ultrasound examination of the brain can be also helpful in the diagnosis of meningitis. The combination of clinical manifestations, risk factors and the results of laboratory tests will enable to form a group of high-risk newborns with suspected meningitis in whom a lumbar puncture should be performed. The diagnosis of bacterial meningitis will be supported by an increased concentration of CRP and procalcitonin in the cerebrospinal fluid.

Keywords:

ultrasound – Meningitis – newborn – cerebrospinal fluid – lumbar puncture

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