Meningitis in newborn infants

Meningitis is the inflammation of the meninges (the membrane lining of the brain and spinal cord). It usually refers to infections caused by viruses, bacteria, fungi or other micro-organisms.  

This information on newborn infants and meningitis concentrates on two forms of bacteria that can cause meningitis, Group B streptococcus and Escherichia coli (E. coli). Newborn infants are at higher risk of infection from certain bacteria because their immune systems are not fully developed.

Meningitis and septicaemia (blood poisoning) can occur in babies and may be caused by a number of different bacteria including:

  • Group B Streptococcus
  • Escherichia coli (E. coli) bacteria

And less commonly,

  • The pneumococcus bacteria
  • Haemophilus influenzae B (Hib) and
  • The meningococcus bacteria.

What are the signs and symptoms of meningitis and septicaemia in babies?

Signs and symptoms of meningitis and septicaemia

The symptoms of meningitis and septicaemia (blood poisoning) may include:

  • Fever, possibly with cold hands and feet
  • Refusing feeds or vomiting
  • High pitched moaning cry or whimpering
  • Dislike of being handled or fretful behaviour
  • Neck retraction with arching of the back
  • Blank staring expression
  • Child is difficult to wake or lethargic
  • Pale blotchy complexion
  • Bulging soft spot on the head - bulging fontanelle
  • A rash
  • Diarrhoea
  • Floppy or stiff body or jerking body movements
  • Breathing problems or increased rate of breathing

The symptoms do not need to occur in any order and may not all be present. Babies become ill very quickly. If you think a baby is ill or may have meningitis and/or septicaemia seek medical attention and advice urgently.

 

How are babies exposed to bacteria that can cause meningitis?

Babies may be exposed to certain bacteria (such as pneumococcus, the meningococcus and Hib (Haemophilus influenzae B), through respiratory-borne secretions but very few become ill. However, sometimes babies can develop:

  • Meningococcal meningitis after exposure to meningococcus germs
  • Pneumococcal meningitis after exposure to pneumococcus germs
  • Or less frequently Hib meningitis after exposure to Hib (Haemophilus influenzae B) germs.

Babies may also be exposed during birth to other bacteria found normally in the vagina. For example, Group B Streptococcus are found in the vagina of some expectant mothers and babies may be exposed to the bacteria during vaginal delivery.

However the vast majority of babies who are exposed to the bacteria will not become ill.

Babies are at increased risk of contracting meningitis or septicaemia if:

  • They are low birth weight
  • Born too early
  • The delivery is difficult
  • The membranes (walls of the bag that hold the developing foetus/infant and the fluid that surround the foetus during pregnancy [1]) are ruptured too early [2,3].

 

Are there any vaccines to protect against these bacteria?

There are currently a number of vaccines to protect against some forms of pneumococcal, Hib and meningococcal disease. However because they are generally not effective in the time immediately after birth, they are only given to the baby when they are 1 to 2 months old - when the baby's immune system can respond appropriately.

Currently there is no vaccine to protect against infection from Group B Streptococcus or E coli.

Please speak to your doctor about vaccination.

 

Infection with Group B Streptococcus Bacteria

Group B Streptococcus or Streptococcus agalactiae is the most common cause of life threatening infections in newborn infants [4].

 Group B Streptococcus lives in the body of some people without causing any harm at all [5]. It colonises or lives in the intestines of many people and is also found in the vagina. Approximately 10 to 30% of women carry the bacteria in their genital and/or intestinal tracts. The baby can sometimes be exposed to the bacteria from these regions and from this exposure, can sometimes be infected during delivery, which can result in serious illness in the newborn baby. However only a very small percentage of babies develop early onset Group B Streptococcal disease if their mothers carry the bacteria [6].

The Group B Streptococcus bacteria are usually passed on to a baby during birth if the mother carries the bacteria. Sometimes, the baby may acquire the infection when still in the womb. Either circumstance may lead to what is known as "early onset" meningitis. Early onset meningitis usually occurs in the first few hours or days of life, the exact timing being dependent upon when the baby became infected.

In some babies, a "late onset" form of meningitis may develop. Late onset disease is usually considered to be disease occurring from about one week until one month [7] or so after birth. Reasons for the baby developing late onset meningitis are varied ranging from taking longer to develop an infection from smaller numbers of bacteria acquired at birth; to being infected by bacteria acquired after birth, e.g. from a breast infection.

In very rare cases, babies may acquire Group B Streptococcus in their body in other ways, and in a small number of cases can develop Group B streptococcus meningitis. This may occur either through:

  • Ingestion of Group B streptococcus infected breast milk
  • The baby acquiring the bacteria from its immediate environment
  • The baby becoming infected by others who may be carrying the Group B Streptococcus bacteria

Consequently, adopting good hygiene practices is potentially useful in reducing risk of contracting Group B Streptococcus meningitis. As there are many more important factors affecting whether a newborn develops meningitis or not, should your child develop meningitis, this doesn't mean your standard of hygiene was poor.

 Currently, expert medical opinion does not recommend routine screening of parents or care givers to see if they are carrying Group B streptococcus once a baby is born.

There are certain clinical risk factors that can increase the chance of Group B streptococcus infection being passed from carrier mother to the newborn. These clinical risk factors include:

  • Going into labour before 37 weeks
  • High fever during labour
  • Rupture of membranes (walls of the bag that hold the developing foetus/infant and the fluid that surrounds the foetus during pregnancy [8]) more than 18 hours before birth.

In women who are carriers of Group B Streptococcus bacteria and have one or more of these clinical risk factors, about 5 in 100 babies will develop infection.

In women who are carriers but don't have any clinical risk factors, about 1 in 200 babies will develop infection.

The reported worldwide incidence of infection with Group B Streptococcus varies between approximately 1 and 4 per 1000 births [9]. Recent Australian rates of infection are 0.25 per 1000 live births [10].

What are the strategies to decrease Group B Streptococcus infection of babies?

A simple laboratory test for the presence of the bacteria (or carriage of the bacteria) in pregnant women can be done at 35 weeks. For women found to be carriers, antibiotic treatment can be given to the mother at delivery to prevent infection to the newborn.

Other alternative strategies to decrease Group B Streptococcus infection of babies do not involve screening pregnant women for carriage of the bacteria. Instead if certain risk factors are present during delivery, antibiotics are given to the mother to prevent infection to the newborn baby.

It remains unclear which of these two strategies is the most effective. Pregnant women should discuss Group B Streptococcus and the associated risks to their pregnancy with their obstetrician and/or general practitioner (GP).

 

How is Group B Streptococcus meningitis or septicaemia diagnosed and treated?

Group B Streptococcus infection is usually diagnosed by isolating the bacteria from samples of blood and cerebrospinal fluid [11]. Treatment usually involves the administration of intravenous antibiotics for a few days to weeks for serious disease such as meningitis.

It is very rare for a baby with Group B streptococcus infection to spread the infection to other babies, children or adults.

Currently (at time of writing) there is no vaccine for Group B streptococcus.

 

Infection with E. coli bacteria

E.coli (Escherichia coli) can also cause life threatening disease in newborn babies.

E coli are common bacteria found in the bowel or large intestine of healthy people and are important in maintaining health[12]. Most strains of E. coli do not cause disease.

Sometimes E. coli can cause infections when they gain access to areas of the body in which they are not normally found, such as the blood stream, urinary tract or meninges. E. coli can also be found in the vagina as part of the normal bacteria which reside there, and babies may be exposed to the bacteria during delivery [13].

Recent Australian data has shown an incidence rate of newborn E.coli infections of 0.32 per 1000 live births, which is slightly higher that that for Group B Streptococcus [14].

Premature babies are at significantly increased risk of contracting E. coli meningitis if they:

  • Have experienced a long or difficult labour
  • Have a low birth weight
  • Have problems with their immune system.

E.coli infection is usually diagnosed by isolating the bacteria from samples of blood and cerebrospinal fluid. Treatment usually involves the administration of intravenous antibiotics for many weeks.

Currently (at time of writing) there is no vaccine for E.coli. However, routine good hygiene measures may possibly reduce the risk of a baby acquiring a virulent E. coli strain, and thus reduce the risk of subsequent E.coli meningitis.

Currently, expert medical opinion does not recommend routine screening of parents or care givers to see if they are carrying E.coli as carriage is universal in humans.

 

Other bacteria that cause meningitis

For information on meningitis caused by meningococcus, pneumococcus or Hib (Haemophilus influenzae B) bacteria, please refer to our website for further information.

In rare cases, other bacteria may also cause meningitis in newborns. These may include Klebsiella species, Enterobacter species, Salmonella species and occasionally Listeria monocytogenes [15,16,17].

 

Disclaimer

The Meningitis Centre is a 'not for profit' support organisation based in Australia, not a professional medical authority. Consequently the text on this web site provides general information about meningitis. It is not medical advice and is not intended for use in the diagnosis or treatment of the diseases. Please consult your doctor to discuss the information or if you are concerned someone may be ill. Medical information and knowledge changes quickly and you should contact your doctor for further information or if you are concerned about your health.

 

References

[1] Anderson K, et al. Mosby's Pocket Dictionary of Nursing, Medicine and Professions Allied to Medicine. UK Edition ed. London: Mosby; 1995.
[2] Group B Strep Support. Who is Most at Risk [online]. 2003 [cited 6 September 2005] Available from: www.gbss.org.ek/
[3] Jeffery H. Department of Neonatal Medicine Protocol Book
Prevention and Treatment of Early Onset Group B Streptococcal Disease (EOGBSD) in Neonates [online]. 2002 [cited 6 September 2005] Available from: www.cs.nsw.gov.au/rpa/neonatal/html/newprot/GBS Protocol.htm
[4] Saez-Lorens X, McCracken JGH. Bacterial Meningitis in children. The Lancet June 2003;361:2139-48.
[5] Meningitis Research Foundation. E. coli (Escherichia coli) meningitis [online]. 2002 [cited 6 September 2005] Available from: http://www.meningitis.org/index.jsp?page=/content.jsp?sectno=5&subno=7&pageno=2
[6] State Government of Victoria, Department of Human Services. Group B streptococcal disease [online]. 2003 [cited 6 September 2005] Available from: http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Group_B_streptococcal_disease?open
[7] Jeffery H. Department of Neonatal Medicine Protocol Book
Prevention and Treatment of Early Onset Group B Streptococcal Disease (EOGBSD) in Neonates [online]. 2002 [cited 6 September 2005] Available from: www.cs.nsw.gov.au/rpa/neonatal/html/newprot/GBS Protocol.htm
[8] Anderson K, et al. Mosby's Pocket Dictionary of Nursing, Medicine and Professions Allied to Medicine. UK Edition ed. London: Mosby; 1995.
[9] Connellan M., Wallace E M. Prevention of perinatal group B streptococcal disease: screening practice in public hospitals in Victoria. MJA 2000;172:317 - 20.
[10] Daley A J, Isaacs D. Australasian Study Group Neonatal Infections. Pediat Infect Dis J, 2004;23(7):630 -4.
[11] Beeby P, Royal Prince Albert Hospital. Department of Neonatal Medicine Protocol Book, Neonatal Bacterial Infection [online]. 2002 [cited 3 November 2004] Available from: www.cs.nsw.gov.au/rpa/neonatal/html/newprot/earlyinf.htm
[12] Meningitis Research Foundation. E. coli (Escherichia coli) meningitis [online]. 2002 [cited 6 September 2005] Available from: http://www.meningitis.org/index.jsp?page=/content.jsp?sectno=5&subno=7&pageno=2
[13] Meningitis Research Foundation. E. coli (Escherichia coli) meningitis [online]. 2002 [cited 6 September 2005] Available from: http://www.meningitis.org/index.jsp?page=/content.jsp?sectno=5&subno=7&pageno=2
[14] Daley A J, Isaacs D. Australasian Study Group Neonatal Infections. Pediat Infect Dis J, 2004;23(7):630 -4.
[15] Saez-Lorens X, McCracken JGH. Bacterial Meningitis in children. The Lancet June 2003;361:2139-48.
[16] Meningitis Research Foundation. About the diseases - Listeria [online]. 2004 [cited 6 September 2005] Available from: http://www.meningitis.org/
[17] Meningitis Research Foundation. About the diseases - Rarer types - Salmonella meningitis [online]. 2004 [cited 6 September 2005] Available from: http://www.meningitis.org/