Buzz
Meningitis occurs when an infection leads to inflammation and swelling of the meninges, the protective membranes surrounding the brain and spinal cord. Symptoms in infants may manifest as a bulging fontanelle, fever, rash, stiffness, rapid breathing, lethargy, and crying. If you suspect your baby is exhibiting these or any other symptoms and sense something is amiss, seek immediate medical attention at the emergency room.
Procedures
Evaluating Your Baby for Indications
Recognize early indicators. Initial signs of meningitis include vomiting, fever, and headaches. Detecting these signs in babies requires special attention, as they cannot articulate their discomfort verbally. Meningitis symptoms can escalate rapidly within 3 to 5 days of onset, underscoring the urgency of seeking medical assistance for your baby without delay.
Check your baby's head. Gently examine your baby's head, feeling for any bulging or tense spots. Bulging soft spots, usually found on the sides of the head in the fontanelle regions, could be a sign of various conditions, including meningitis. Regardless, a bulging fontanelle always warrants immediate attention, so take your baby to the emergency room without delay. Other conditions that may cause a bulging fontanelle include:
- Encephalitis, characterized by brain swelling often due to an infection.
- Hydrocephalus, caused by fluid buildup in the brain due to an obstruction or narrowing of ventricles that channel fluid out.
- Increased intracranial pressure due to fluid accumulation, which can restrict blood flow to the brain.
Monitor your baby's temperature. Use an oral or rectal thermometer to check for fever. A temperature above 37.5ºC (99.5ºF) may indicate a fever. Depending on your baby's age, a very high temperature could signal a medical emergency:
- For infants under 3 months, seek medical attention for a temperature above 38°C (100.4°F).
- For babies aged 3–6 months, seek attention for a fever above 39ºC (102.2ºF).
- If your baby is older than 6 months, seek attention for a fever above 40°C (104°F).
- However, do not rely solely on a high temperature to determine if you should take your baby to the emergency room, as babies under three months with meningitis may not always have a fever.
Listen to your baby's cries. If your baby is unwell, she may display signs of irritability such as crying, moaning, or thrashing, especially when you pick her up due to achy muscles and joints. While stationary, she may remain quiet but start crying loudly when picked up.
- Listen for changes in your baby's crying that may indicate pain or discomfort. She may whimper excessively or emit cries that are higher than usual in pitch.
- Your baby may also cry with pain or extreme discomfort when cradled or when the neck area is touched.
- Bright light may also trigger crying due to photophobia.
Look out for signs of stiffness in your baby's body. If meningitis is suspected, observe your baby for stiffness, particularly in her neck. She may be unable to touch her chest with her chin and may exhibit jerky, abrupt movements.
Inspect your baby's skin for discoloration and rashes.
Examine your baby's skin tone and complexion, looking for extreme paleness, blotchiness, or a bluish hue.
- Check for rashes that appear pink, purple-red, or brown, or ones that form clusters of pin-prick dots resembling bruises.
- If uncertain about blotchy spots on your baby's skin, perform the tumbler/glass test by gently pressing a clear drinking glass against the affected area. If the rash remains visible under the glass, seek immediate medical attention. In darker-skinned babies, examine areas such as the palms, soles, stomach, or near the eyelids for red dots or pinpricks.
Observe the baby's feeding habits. Your baby may show a decreased appetite, refusing food and vomiting after eating.
Assess the baby's energy levels. Look for signs of weakness such as limpness, lethargy, and constant sleepiness, which can occur as the infection progresses through the meninges.
Monitor the baby's breathing. Watch for irregular breathing patterns, including rapid breathing or difficulty breathing.
Check for signs of coldness in the baby's body. Notice if the baby experiences constant shivering and feels unusually cold, particularly in the hands and feet.
Understand meningitis. Meningitis occurs when an infection inflames and swells the meninges, the tissue surrounding the brain and spinal cord. The infection is typically caused by bacterial or viral invasion. Causes of meningitis include:
- Viral: The most common type worldwide, often resolving without treatment but requiring medical attention to prevent potential complications. Following immunization protocols is crucial for infants and children. Mothers with active herpes simplex virus (HSV-2) lesions can transmit the virus to their newborns during delivery.
- Bacterial: Common in newborns and infants.
- Fungal: Uncommon and primarily affecting individuals with compromised immune systems, such as AIDS patients, transplant recipients, and chemotherapy patients.
- Miscellaneous: Other types may result from chemical exposure, medication reactions, inflammation, or cancer.
Consulting with a Doctor for Diagnosis
Describe all symptoms to the doctor. Ensure you communicate all symptoms, even seemingly minor ones like sneezing or coughing. This assists the doctor in distinguishing between different meningitis types and proceeding with appropriate diagnostic tests. Immediately inform the doctor about severe symptoms such as seizures, loss of consciousness, or muscle weakness, which may necessitate emergency care.
Inform your doctor of potential bacterial exposure. Various bacterial strains can cause meningitis. If your baby has had contact with individuals with gastrointestinal or respiratory illnesses, they may have been exposed to bacteria such as Strep B (including strep agalactiae), E. coli, Listeria species, Neisseria meningitidis, S. pneumoniae, or Haemophilus influenzae.
Arrange a thorough physical examination for your baby. The doctor will assess your baby's vital signs and medical history, including temperature, blood pressure, heart rate, and respiratory rate.
Allow the doctor to collect blood samples. Blood will be drawn from your baby's heel for a complete blood count, examining electrolyte levels, red and white blood cell counts, blood coagulation, and bacterial presence.
Discuss the necessity of a cranial CT scan with the doctor. A cranial CT scan examines brain density to detect swelling or hemorrhaging. It's particularly useful after seizures or trauma, helping determine if a lumbar puncture is viable. If intracranial pressure is high, a lumbar puncture is delayed until pressure normalizes.
Consider the need for a lumbar puncture. This procedure extracts cerebrospinal fluid from the lower back to diagnose meningitis. While painful, it's essential for diagnosis, though it's contraindicated in cases of high intracranial pressure, infection at the puncture site, coma, spinal abnormalities, or breathing difficulties. If performed, tests include a gram stain and cerebrospinal fluid analysis.
Receiving Treatment for Meningitis
Seek treatment for viral meningitis. Treatment depends on the viral cause, such as herpes simplex virus (HSV-1). Newborns with herpes encephalitis are treated with intravenous antiviral drugs like acyclovir.
Adhere to the treatment regimen for bacterial meningitis. Treatment varies based on the bacterial cause. Administer medications as prescribed by your doctor, which may include antibiotics like amikacin, ampicillin, cefotaxime, ceftriaxone, chloramphenicol, co-trimoxazole, gentamicin, nafcillin, penicillin G, or vancomycin.
Discuss the treatment duration with the doctor. The duration of your baby's meningitis treatment depends on the underlying cause. Here are some estimated treatment lengths:
- N. meningitidis: 7 days
- H. Influenza: 7 days
- Strep pneumonia: 10 to 14 days
- Group B. Strep: 14 to 21 days
- Gram-negative aerobic bacillus: 14 to 21 days
- Listeria monocytogenes/L. meningitis: 21 days or more
Provide additional supportive care for the baby. Ensure the baby receives proper medication doses throughout treatment. Encourage rest, ample fluid intake, and possibly administer IV fluids due to her age. Take precautions to prevent transmission to other family members.
Post-Meningitis Treatment Follow-Up
Evaluate the baby's hearing post-treatment. Hearing loss is a common meningitis complication, so all babies must undergo auditory evoked potentials studies after treatment.
Monitor intracranial pressure with an MRI. Post-treatment pathogens can lead to complications, including increased intracranial pressure. Schedule a follow-up MRI 7 to 10 days after completing meningitis treatment.
Ensure your child is vaccinated. Make sure your child receives all vaccinations to lower the risk of viral meningitis.
- Reduce the risk of future children contracting meningitis. If you're pregnant and have HSV with genital lesions, inform your doctor before delivery.
Avoid contact with contagious or ill individuals. Certain types of bacterial meningitis are contagious. Keep young children and babies away from contact with contagious or ill individuals.
Know the risk factors. Certain circumstances may increase the risk of contracting meningitis. Some of these include:
- Age: Children under five are at higher risk for viral meningitis, while adults over 20 are at higher risk for bacterial meningitis.
- Living in close quarters: Living in close contact with many people, such as in dormitories, military bases, boarding schools, and child care facilities, can increase the risk of meningitis.
- Decreased immune system: Conditions like AIDS, alcoholism, diabetes, and use of immunosuppressant drugs can compromise the immune system, increasing the risk of meningitis.
Useful Tips
Warnings
Act promptly if you suspect meningitis. Contact your pediatrician or a medical professional immediately if you notice signs like a bulging fontanelle, unexplained rash, or any unfamiliar symptoms in your baby. Quick action can prevent a potentially serious situation from worsening.
