Meningitis in newborns: causes, symptoms, treatment. Possible consequences in infants. Forecast and long-term consequences

Most meningitis is infectious and can be caused by various viruses or bacteria. Meningococcal infection is the most common form of all inflammatory infections of the meninges. This form of infection is recorded in 70-80% of cases in patients with this disease.

Meningitis in the bacterial form is serious and can turn into purulent forms. In most cases, streptococcal and meningococcal forms of meningitis are detected in infants and infants; these infections often lead to serious complications and are difficult.

Serous meningitis is overwhelmingly caused by viruses. These are mainly pathogens that cause rubella and chicken pox. Weakened babies are very susceptible to influenza infection. Problems in the work of the immune system are often fixed, immunodeficiency is observed. Children who have diabetes mellitus or who have been using glucocorticosteroids since birth may develop candidal meningitis.

This disease develops rapidly in a weak child's body. The harmful fungus Candida, which is the cause of candidal meningitis, enters the meninges along with the blood, after which it begins to multiply there, causing severe inflammation. This type of meningitis takes much longer to heal than bacterial meningitis.

The most rare type of meningococcal infection in newborns is the tuberculous variant, which is caused by protozoan microorganisms. This form of the disease occurs only in 2-3% of cases.

When a birth injury occurs, a traumatic form may occur, which is characterized by a severe form of leakage. Patients with this form of meningitis should be advised by a neurosurgeon and regularly monitored by a neurologist.

Examination methods

Extraction of cerebrospinal fluid (CSF) using a special needle for examination. Liquor constantly circulates in the ventricles of the brain. Taken into account:

• general blood analysis;
• c-reactive protein level;
• blood glucose;
• electrolytes;
• the process of blood clotting;
• the presence of bacteria.

The examination is based on the results of methods associated with the isolation of a culture of microorganisms from cultures of cerebrospinal fluid and blood. They may be positive in over 80% of patients who have not received antibiotic therapy. This type of therapy promotes negative cultures due to accumulation of pus in the brain, which can be caused by a specific bacteria, the herpes enterovirus.

Due to an infectious disease, which is meningitis in a newborn, there is an increase in protein in the cerebrospinal fluid and a decrease in the concentration of glucose. The increase in leukocytes is associated with the presence of white cells involved in maintaining human immunity over 90% in some cases.

To make a diagnosis of meningitis, it is necessary that leukocytes in the cellular composition of the cerebrospinal fluid exceed 21 cells per 1 mm3. Microscopic study of cells obtained from the focus of pathology and the diagnosis of diseases that lead to metabolic disorders may not give the proper result.

The concentration of glucose in the cerebrospinal fluid in a child who was born prematurely is from 55 to 105%, compared with the blood glucose level in a child born at the due date from 44 to 128%. The presence of protein is less than 0.3 g/l or more than 10 g/l.

• positive blood culture;
• the presence of a bacterial disease, which is manifested by foci of purulent inflammation, which is confirmed by data from clinical and laboratory studies;
• the condition noticeably worsens when antimicrobials are used in therapy.

The procedure for inserting a needle into the space of the spinal cord in order to diagnose the composition of the cerebrospinal fluid at the level of the lumbar may be delayed until the patient's condition returns to normal, despite the delay in accurate diagnosis, as well as the likelihood of incorrect medication.

If a newborn child suspected of having meningitis or sepsis has inadequate cerebrospinal fluid parameters, with a negative blood culture and CSF, it is worth re-diagnosing.

To exclude various infections and check for the presence of herpes, toxoplasmosis. With a late analysis of more than two hours, a significant decrease in the number of leukocytes and glucose saturation in the cerebrospinal fluid can be observed. It is best if the tests are with a specialist after half an hour.

Meningitis with CSF values ​​within the normal range is observed in 30% of newborns. Even if the diagnosis is confirmed by microbiological examination, it is not always the cause of changes in the composition of the cells of the cerebrospinal fluid.

Indicators can be on the verge of normal and abnormal. In this case, it is necessary to conduct a survey of newborn patients for the presence of infections that could be transmitted directly from the mother. This applies to herpes, HIV, rubella, syphilis.

Microscopic examination of a native smear. Bacteria can be present in the cerebrospinal fluid in 83% of newborns, which is caused by group B streptococcus. At the same time, in 78% of patients in this group, meningitis appears due to gram-negative microorganisms.

The chance of detecting bacteria in this test is related to their presence in the cerebrospinal fluid. Important in making a diagnosis is the identification of a culture from the CSF, which does not depend on the data obtained from additional procedures.

The virus isolated from the blood is not always associated with a culture of cerebrospinal fluid, and therefore a detailed diagnosis of CSF is necessary. Extraction of cerebrospinal fluid using a special needle that constantly circulates in the ventricles of the brain is necessary if meningitis has not been detected during clinical and microbiological studies.

Treatment

The quality of getting rid of the disease directly depends on the cause of its occurrence, namely: on the pathogen. Purulent type meningitis occurs from a bacterial, fungal or viral infection. In the treatment, methods are used that are aimed at eliminating the pathogen.

This disease is quite dangerous with possible bad consequences, which is why a hospital stay is required. It is extremely important in case of meningitis in a premature baby, treat it only in the hospital, since the baby's body is very weak.

Treatment courses consist of injections of antibiotics, antiviral or antifungal medicines. Medicines are administered in significant volumes until the complete disappearance of the symptoms of the disease. To confirm complete recovery, a re-examination of the CSF is required.

Negative consequences of the disease

Including with timely diagnosis of the disease, the consequences are often negative. If the baby is premature, this only exacerbates the possibility of complications.

Meningitis in babies can lead to the following conditions:

• brain abscess.
• Lagging behind the age norms of development.
• Dementia.
• Hearing loss.
• Loss of vision.
• Dropsy of the brain.
• epileptic seizures.
• development of paralysis.
• Damage to the nervous system.

In 30% of cases of the development of the disease in premature babies, therapeutic measures do not have the proper effect on the body and the situation ends in death.

In children under the age of 1 year, there is a risk of viral meningitis as a complication after ARVI, influenza, and various diseases. In weakened, often ill children, the development of a serous type of the disease is possible. Fungal meningitis caused by candidiasis is also common.

Dangerous symptoms that you should pay attention to and immediately visit a doctor:

• intoxication of the body;
• diarrhea;
• nausea and vomiting;
• increase in body temperature;
• unexplained crying of a child.

Often, you can begin to suspect an inflammatory process in the meninges when the baby screams in bright light and loud sound. Thus gives the manifestation of soreness in the head during meningitis. In this condition, the lack of urgent medical attention can only aggravate the situation, for example, convulsive seizures.

In such a case, treatment is carried out in a hospital with the help of drugs that destroy the causative agent of the disease.

In children older than 2 years, the causes of meningitis can be:

• viral microorganisms of other diseases such as rubella, chickenpox;
• microbes;
• fungal infections;
• bacteria.

Often occurs after contact with stray animals that are carriers of viruses, or with a sick person. Most meningococcal infections occur due to the entry of harmful microorganisms into the human body. Often these are harmful bacteria or viral pathogens.

The undisputed leader among the causes that cause inflammation in the meninges is. This type of meningitis occurs in the vast majority of cases, while the bacterial forms of meningitis are acute and can turn into purulent forms.

Often, newly born babies and infants are susceptible to infection with streptococcal or meningococcal infection. Data diseases are difficult to cure and have a high risk of complications. Serous meningitis is always caused by the ingestion of viruses.

The causative agent of the disease can be the rubella virus, smallpox, etc. The influenza form is often observed in children with poor health. Often these children are found to have abnormalities in the functioning of the immune system. People who have been diagnosed with diabetes can get sick with candidal meningitis, which, along with the flow of blood, can get into the meninges, where it causes severe inflammation.

Such a disease is treated much longer than. Rarely, doctors detect a tuberculosis form. This type occurs in 2-3% of the total number of patients with this type of infection. Traumatic form can occur with birth trauma.

The disease begins to progress in the first days or months after birth. In most cases, the traumatic form causes various complications. During treatment, it is necessary to undergo regular examinations by a neurologist and a neurosurgeon.

Meningitis is a specific disease of the lining of the brain that affects the central nervous system. Inflammation of the meninges occurs due to the introduction of microbial agents (viral, bacterial). Changes in the lining of the brain can lead to low immunity, chronic diseases, and anomalies in the development of the skull.

Causes of meningitis in children

The main cause of the disease are specific agents that affect the lining of the brain. The most common infectious agents are:

• Viruses: adenoviruses, influenza virus, measles, rubella, herpetic viruses (in particular chickenpox).
• bacteria. It can be meningococcus, various types of staphylococcus and streptococcus, syphilis pathogens, pneumococcus.
• Fungi(cryptococcus).
• Protozoa(toxoplasma).

In different age groups, there is a predominance of one or another pathogen as the cause of meningitis. The following patterns are observed:

• newborns rarely get meningitis. This kind of disease can be transmitted in utero from mother to fetus. Usually it is a herpetic or toxoplasma infection.
• In infants meningitis is caused by the immunodeficiency virus or congenital syphilis.
• For children under one year old The causative agent is often a bacterium such as meningococcus.
• At school age staphylococcus and streptococcus bacteria predominate.
• Teenagers a wider range of pathogens. Also, the diagnosis of a tuberculous process with brain damage is not excluded.

Ways of contracting meningitis

Most infectious agents are transmitted by airborne droplets. That is, when communicating with a sick person of any age, a child can catch the disease. Bacterial meningitis is transmitted through the use of shared things: toys, utensils, etc.

The following contribute to the development of meningitis:

• Chronic diseases of the ENT organs (adenoiditis, sinusitis, otitis).
• (anomalies in the development of the skull).
• B mouth ulcers (carious teeth in children).

All these reasons reduce the immunity of the baby and allow agents to freely penetrate into the brain area.

Meningitis in children: classification

Table number 1. Classification of meningitis in children.

Meningitis is an inflammation of the lining of the brain or spinal cord. An infectious disease - it is the infection of the body with a certain bacterium that leads to the formation of purulent cavities in the brain.

Among newborns and infants, meningitis is quite common, if treatment is not started immediately, complications and serious consequences may occur, in the worst case, the child dies.

Features of the disease in newborn babies

In newborn babies, it most often develops due to birth trauma, prematurity of the fetus, or sepsis.

Often the infection enters through the umbilical vessels or the placenta during the mother's illness with pyelitis or pyelocystitis during pregnancy. Causative agents of infection: streptococci, staphylococci and E. coli, other types of bacteria are rare.

Meningitis in infants is characterized by a severe form of the disease, dehydration, disorders of the gastrointestinal tract, and the absence of high temperature.

Strong excitability or complete lethargy - these manifestations are similar to other pathologies, therefore, the diagnosis can be confirmed in a hospital setting by sampling cerebrospinal fluid for examination.

It is not always possible to cure such a small patient completely. They have a high percentage of complications in the form of CNS disorders:

• mental retardation;
• limbs and cranial nerves.

These children are under the supervision of specialists for a long time, regularly undergo examinations to avoid re-infection.

Disease danger

Meningitis in infants from birth to a year is very dangerous because half of the cases end in death, and the other half, cured of the disease, receive complications leading to disability: deafness, blindness, mental retardation.

After treatment, the baby begins a long-term rehabilitation, the first 2 years of which he must be under the constant supervision of specialists, since there is a risk of occurrence - a complication can develop at any age and lead to a sharp deterioration in the child's health.

The danger of this disease is also that the child does not always have pronounced symptoms, for example, high fever. This is due to the lack of formed temperature control. Therefore, with symptoms similar to meningitis, they immediately call an ambulance team, and do not self-medicate.

Risk factors

In a newborn child, meningitis develops as an independent disease, the cause of its occurrence is the infection in the baby's body. The most common pathogens in this case are staphylococcus aureus, E. coli and streptococcus.

A high probability of the disease in those children who have had damage to the central nervous system before or during childbirth. If a child has a weakened immune system or a pathology has developed in utero, then the child is at greater risk of developing meningitis.

At risk are children born prematurely. Statistics show that boys are more likely to get meningitis than girls.

Features of the clinical picture

The clinical picture of meningitis in newborns is manifested by common neurological symptoms:

• lethargy;
• reduced motor activity;
• drowsiness;
• frequent regurgitation and vomiting;
• breast rejection;
• groaning breathing and signs of suffocation.

Children weighing more than 2 kilograms may suffer from a rapid rise in temperature to 39 degrees. In infants, signs of meningitis can be seen in the swelling and increased pulsation of the fontanel, convulsions and tilting the head back.

In premature babies and those with low weight, the clinical picture may look different, proceed in a sluggish form and manifest itself only at the height of the disease. This applies to the absence of bulging and pulsation of the fontanel, tilting the head. This "erased" clinic occurs with children born prematurely and treated with antibiotics from birth.

The disease can develop rapidly, or it can be protracted - depending on the age, weight and condition of the child. This creates difficulties in diagnosing, but a correct diagnosis can be made by performing a lumbar puncture.

Varieties of the disease

The most common types of meningitis in infants are:

1. - occurs against the background of influenza, measles, chickenpox and paratitis, so it is difficult to diagnose.
2. Fungal- occurs in newborns born prematurely and in children with a weakened immune system. The child runs the risk of becoming infected with it right in the hospital if hygiene rules are not followed.
3. - occurs most often, is caused by any purulent inflammation, if an infection has penetrated. With blood, it reaches the membranes of the brain and creates purulent foci. Purulent meningitis in newborns is formed when infected with bacterial species such as Haemophilus influenzae, meningococcus and pneumococcus. In 70% of cases, infection occurs with meningococcal infection, which can be contracted by airborne droplets, through the mouth or nose and from there into the blood. A large number of bacteria that enter the bloodstream causes a rapid course of the disease and after 10-12 hours the child may die.

All types of diseases require different methods of treatment, which the doctor must prescribe, making an accurate diagnosis.

Diagnosis and differentiation

Diagnosis of meningitis in a newborn is carried out according to the identified symptoms and blood sampling for general, biochemical analysis and PCR study.

A puncture is also performed to select cerebrospinal fluid for examination, and a diagnosis is made based on the presence of an inflammatory process.

In special and advanced cases, computed tomography can be performed, and it is also prescribed for differential diagnosis. It is necessary to identify the causative agent of the disease in order to select the appropriate antibiotic for the treatment of meningitis.

Differential diagnosis is carried out according to signs that are specific to this type of meningitis. For example, it manifests itself with an acute onset, vomiting, high fever, and convulsions and impaired consciousness appear later.

At the same time, in the absence of pathology of internal organs, meningococci and an increase in protein in the cerebrospinal fluid are present in the baby's blood. So all types of meningitis have their own characteristic symptoms, which determine the exact diagnosis.

Special approach to therapy

It is important to know that the treatment of meningitis occurs only in stationary conditions. Do not self-medicate or use folk remedies. Therapy should begin with the establishment of the cause of the disease.

In the case of bacterial infection, broad-spectrum antibiotics are used that pass well through the BBB (blood-brain barrier):

• Ceftriaxone;
• Cefotaxime;
• Gentamicin;
• Amoxicillin and other similar drugs.

Drugs are administered in maximum doses with a long course, replacing them after 12 weeks. If the disease is viral or fungal, then antiviral or antifungal agents are administered. Administration of intravenous injections.

Also, the baby is given detoxification, anticonvulsant and dehydration therapy. If it occurs, Dexamethasone is used.

With a viral or fungal infection, the baby recovers in one to two weeks. Bacterial meningitis in infants is treated much longer and depends on the severity of the disease and the body's resistance to the disease.

Severe consequences and poor prognosis

This dangerous disease for newborns does not always end favorably; complications always occur in young children, even
long-term therapy in this case is powerless, the consequences are disorders in the central nervous system, mental retardation, deafness, blindness, and bleeding disorders.

Within two years there is a threat of a brain abscess.

In the case of illness in infants, mortality rates reach 30% and 65% if formed.

The prognosis for meningitis of all types depends on the cause of the disease and the form of its course. Bacterial meningitis occurs in an acute form and can end in the death of the baby. Even if the baby survives, he will have complications that continue for a long time.

Such a child has been registered with pediatricians and infectious disease specialists for a long time, regularly undergoes examinations. If the disease proceeded in a mild form, then the child recovers in a few weeks without consequences.

Viral meningitis occurs in a milder form and disappears after 2 weeks with timely treatment.

What can be done for prevention?

In order to prevent babies born severely weakened, it is necessary to be vaccinated. Since the disease has many different forms, even vaccination cannot guarantee protection against meningitis.

Viral meningitis is spread by airborne droplets, and in order not to become infected, it is required not to violate personal hygiene, to thermally process food and objects that are used by all family members.

When there are patients with acute respiratory infections or acute respiratory viral infections in the family, then a small child must be isolated from the patient. All family members should use Interferon three times a day for a week - this will also reduce the risk of infection.

Also, for prevention, you should drink a complex of vitamins and minerals, eat fortified food, do not overcool and do not walk in crowded places. This will help protect the family from contracting meningitis, including a newborn baby.

In the case of meningitis, the main thing is to quickly start treatment, this is what will help avoid the death of a newborn child and help him recover and increase his chances of survival. Experts say that proper nutrition and good immunity will help the child avoid the disease.

Purulent meningitis in newborns is an inflammation of the meninges, a serious disease that occupies one of the first places among infectious diseases of the central nervous system in young children. The incidence of purulent meningitis is 1-5 per 10 thousand newborns.

It can end in death or disabling complications (hydrocephalus, blindness, deafness, spastic paresis and paralysis, epilepsy, psychomotor retardation up to oligophrenia). The outcome depends on timely intensive treatment started. Etiology and pathogenesis.

According to the etiology, meningitis is divided into viral, bacterial and fungal. The route of infection is hematogenous. Infection of a child can occur in utero, including during childbirth or postnatally. Sources of infection are the urogenital tract of the mother, infection can also occur from a patient or from a carrier of pathogenic microflora. The development of meningitis is usually preceded by hematogenous spread of infection. Microorganisms overcome the blood-brain barrier and enter the CNS. Predisposing factors are maternal urinary tract infections, chorioamnionitis, prolonged anhydrous period (over 2 hours), intrauterine infection, prematurity, intrauterine fetal hypotrophy and its morphofunctional immaturity, asphyxia of the fetus and newborn, intracranial birth trauma and related therapeutic measures, malformations of the central nervous system and other situations where there is a decrease in immunological protective factors. The penetration of a bacterial infection into the child's bloodstream is facilitated by inflammatory changes in the nasal and pharyngeal mucosa during acute respiratory viral infection, which, according to our observations, often accompanies the onset of purulent meningitis.

Streptococcus agalactiae (group B beta-hemolytic streptococcus) and Escherichia coli are common causative agents of meningitis. Meningococcal etiology of purulent meningitis in newborns is now rare, which, apparently, is due to the passage of immunoglobulin G containing antibodies to meningococcus through the placenta of the mother to the fetus. Intrauterine meningitis, as a rule, is clinically manifested in the first 48-72 hours after birth, postnatal meningitis appears later. According to our data, such children were admitted to the clinic on the 20th-22nd day of life, when there was a decrease in the content of immunoglobulin G obtained from the mother in the blood serum of the newborn. By this time, maternal immunoglobulin G is catabolized and its blood level decreases by 2 times.

Postnatal meningitis can also develop in intensive care units and intensive care units and in the departments of nursing premature babies. Their main pathogens are Klebsiella spp., Staphylococcus aureus, P.aeroginosa and fungi of the genus Candida. As our observations showed, in the anamnesis of mothers there were such risk factors as the threat of abortion, infection of the urinary system, the presence of chronic foci of infection in pregnant women (tonsillitis, sinusitis, adnexitis, vaginal thrush), as well as a long anhydrous interval in childbirth (from 7 to 28 hours).

Despite the variety of causative agents of purulent meningitis in newborns, the morphological changes in the central nervous system are similar in them. They are localized mainly in the soft and arachnoid membranes. Removal of exudate occurs by phagocytosis by macrophages of fibrin and necrotic cells. In some, it undergoes organization, which is accompanied by the development of an adhesive process. Violation of the patency of the cerebrospinal fluid can lead to the development of occlusive hydrocephalus. Reparation can be delayed for 2-4 weeks or more.

Clinic and diagnostics

There are difficulties in diagnosing purulent meningitis both at home and when a child is admitted to a hospital, since clear clinical manifestations develop later, and at first there are nonspecific symptoms similar to many infectious and inflammatory diseases (pallor, marbling, cyanosis of the skin, conjugative jaundice, hyperesthesia , vomit). Some children have an increase in temperature to subfebrile figures. Symptoms of the disease develop gradually. The child's condition is progressively deteriorating. The temperature rises to 38.5-39oC. On examination, the skin is pale, sometimes with a grayish tint, acrocyanosis, marbling are often noted, sometimes conjugative jaundice is expressed in children. There are violations of the respiratory system - a decrease in the frequency of breathing, apnea attacks, and bradycardia is characteristic of the cardiovascular system. Patients also have hepato- and splenomegaly.

In the neurological status, some newborns show signs of CNS depression: lethargy, drowsiness, weakness, decreased physiological reflexes, and muscle hypotension. Others have symptoms of CNS excitation: restlessness, hyperesthesia, painful and piercing scream, tremor of the chin and limbs, foot clonuses. Cranial nerve disorders may present with nystagmus, eyeball floaters, strabismus, and the "setting sun" sign. Some children experience regurgitation and repeated vomiting, sluggish sucking, or refusal of the breast and nipples. A sick child is not gaining weight well. In later periods, head tilting back, meningeal symptoms (tension and bulging of the large fontanel, stiffness of the muscles of the back of the neck) appear. Characteristic posture of the child on the side with the head thrown back, legs bent and pressed to the stomach. Meningeal symptoms typical of older children (Kernig, Brudzinsky) are uncharacteristic for newborns. Sometimes a positive symptom of Lessage is noted: the child is lifted up, taking the armpits, and at this time his legs are in a flexion position. Polymorphic convulsions, paresis of cranial nerves, changes in muscle tone can be observed. The cause of the development of seizures are hypoxia, microcirculatory disorders, cerebral edema, and sometimes hemorrhagic manifestations. In some cases, there is a rapidly progressive increase in head circumference, divergence of cranial sutures due to intracranial hypertension.

Analysis of the case histories of newborns with purulent meningitis who were in our clinic revealed that all of them were admitted at the age of 7 to 28 days of life (mean age - 23 days). When sent to the hospital, only 2 children were suspected of purulent meningitis, the rest of the referral diagnosis was acute respiratory viral infections, enterocolitis, conjugative jaundice, intrauterine infection, infection of the urinary system, osteomyelitis. At admission, the majority of newborns did not show clear and characteristic signs of meningitis. However, anamnestic data and a serious condition suggested that the disease began earlier, which was confirmed by studies of the cerebrospinal fluid. At admission, most of the children had an increase in temperature up to 38-39.6°C. As a rule, there were no pronounced catarrhal phenomena. Some children in the clinical picture had manifestations of a local purulent infection (purulent conjunctivitis, omphalitis, infection of the urinary system).

In the blood test, most children showed inflammatory changes in the form of an increase in the number of leukocytes (13-34.5x109/l) with a significant increase in the number of stab neutrophils up to the appearance of young forms, as well as an increase in ESR up to 50 mm/hour.

Changes in urine tests (leukocyturia) were observed in three children with a combination of purulent meningitis with pyelonephritis.

To confirm the diagnosis, lumbar puncture should be performed at the slightest suspicion of meningitis, in the early stages, without waiting for the development of its detailed clinic. In cases where for some reason it is not possible to perform a lumbar puncture, one should focus on the clinical picture of the disease. During lumbar puncture with purulent meningitis in newborns, the cerebrospinal fluid often flows out under pressure, cloudy, sometimes, with large cytosis, yellow, thick. Shock and DIC are contraindications for lumbar puncture.

In our observations, almost all admitted children were diagnosed on the first day of their stay in the hospital. The indications for urgent lumbar puncture were the presence of febrile temperature (above 38°C), symptoms of infectious toxicosis without a visible focus of bacterial infection, less often hyperesthesia. In the cerebrospinal fluid, there was an increase in the content of leukocytes with a predominance of the neutrophil link (more than 60%).

With purulent meningitis, the content of total protein in the cerebrospinal fluid increases later than neutrophilic pleocytosis increases. The protein content increases from the onset of the disease and can serve as an indicator of the duration of the pathological process. In our studies, the protein concentration ranged from 0.33 0/00 to 9 0/00. An increased protein content in the cerebrospinal fluid obtained during the first puncture was found in 10 patients, which indicated a certain duration of the disease. Purulent meningitis is characterized by a low level of glucose in the cerebrospinal fluid.

In order to identify the pathogen and determine its sensitivity to antibiotics, a microbiological study of the cerebrospinal fluid is carried out. In our observations, clinical and laboratory data indicated the purulent nature of meningitis, while CSF culture and smear bacterioscopy in most cases did not reveal the pathogen. Group B beta-hemolytic streptococcus was detected in two patients, Haemophilus influenzae was sown in one patient, and pneumococcus was inoculated in another.

Viral meningitis is characterized by serous inflammation of the meninges with an increase in the content of lymphocytes in the cerebrospinal fluid. Serous meningitis is characterized by a milder course.

Instrumental methods include ultrasound examination of the brain (neurosonography) and computed tomography, which are performed according to indications.

Neurosonography allows diagnosing ventriculitis, expansion of the ventricular system, the development of a brain abscess, as well as identifying severe concomitant intracranial hemorrhages, ischemic infarcts, and malformations.

Computed tomography is indicated to rule out a brain abscess, subdural effusion, and to identify areas of thrombosis, infarcts, and hemorrhages in brain structures.

Complications

The most common early complications are swelling and swelling of the brain and convulsions.

Clinically, cerebral edema is manifested by increasing intracranial hypertension. During this period, the posture of a newborn with his head thrown back is characteristic, a monotonous, sometimes piercing, cry, sometimes turning into a groan, is noted. Bulging of a large fontanel, its pulsation, divergence of cranial sutures are possible. Cerebral edema can be clinically manifested by impaired function of the oculomotor, facial, trigeminal, and hypoglossal nerves. Coma is clinically manifested by the inhibition of all types of cerebral activity: adynamia, areflexia and diffuse muscular hypotension. Further, the disappearance of the reaction of pupils to light is noted, apnea attacks become more frequent, and bradycardia develops.

With purulent meningitis, convulsive syndrome often develops. At first, convulsions are clonic in nature, and as cerebral edema progresses, they transform into tonic ones.

A very dangerous complication of meningitis is bacterial (septic) shock. Its development is associated with the penetration of a large number of bacterial endotoxins into the bloodstream. Clinically, septic shock is manifested by sudden cyanosis of the extremities, a catastrophic decrease in blood pressure, tachycardia, shortness of breath, groaning weak cry, loss of consciousness, often in combination with disseminated intravascular coagulation. Among the newborns we observed, two children died. One girl was admitted on the 11th day of life and died in the first 6 hours of hospitalization from infectious-toxic shock complicated by disseminated intravascular coagulation. The second girl, aged 17 days, died on the 2nd day after admission. She had intrauterine generalized cytomegalovirus infection and developed purulent meningitis. Severe consequences of purulent meningitis can be hydrocephalus, blindness, deafness, spastic paresis and paralysis, mental retardation, epilepsy.

Differential Diagnosis

Neurological symptoms similar to purulent meningitis can be observed if a newborn has intracranial hemorrhage. These children also have motor restlessness, tremor of the chin and limbs, nystagmus, strabismus, a symptom of the "setting sun". To exclude purulent meningitis, a spinal puncture is necessary. Intraventricular hemorrhage is characterized by the presence in the cerebrospinal fluid of a large number of altered erythrocytes, as well as an increased concentration of total protein in the cerebrospinal fluid from the first days of the disease due to the penetration of plasma proteins and lysis of erythrocytes.

Often, purulent meningitis occurs with vomiting, so it is necessary to carry out a differential diagnosis with pyloric stenosis, in which vomiting is observed with a "fountain" without fever and inflammatory changes in the blood test. Often, when examining the abdomen, a positive hourglass symptom is noted. The main methods for diagnosing pyloric stenosis are esophagogastroduodenoscopy and ultrasound.

Symptoms of excitation of the central nervous system (anxiety, tremor of the limbs and chin, hyperesthesia), similar to purulent meningitis, can occur with influenza and SARS. In this case, meningism occurs - a condition characterized by the presence of clinical and cerebral symptoms without inflammatory changes in the cerebrospinal fluid. Meningism is not caused by inflammation of the meninges, but by their toxic irritation and increased intracranial pressure. During lumbar puncture, the fluid is clear and colorless, flows out under high pressure, often in a jet, but the content of cells, protein, and glucose is normal. Meningismus usually manifests itself in the acute period of the disease and often precedes inflammation of the meninges, which can develop within a few hours after its detection. If meningeal symptoms with influenza and SARS do not disappear, or, moreover, increase, repeated diagnostic spinal punctures are necessary.

Purulent meningitis can occur in a child with sepsis, which significantly aggravates the clinical picture of the disease.

Treatment

Newborns with purulent meningitis need complex treatment, including antibacterial, infusion therapy, substitution therapy with immunoglobulins for intravenous administration. If necessary, hormonal, anticonvulsant, dehydration therapy is carried out. Such children require the most sparing treatment. In the acute period, they are not recommended to breastfeed. They receive expressed breast milk or, if the mother does not have it, formula from a bottle. When the sucking reflex is suppressed, the child is fed through a tube.

Etiotropic antibiotic therapy is the main treatment for newborns with purulent meningitis. It is carried out taking into account the pathogen isolated from the cerebrospinal fluid and its sensitivity to antibiotics. If the pathogen was not found, the effectiveness of antibiotic therapy is assessed according to clinical data and the results of a repeated examination of the cerebrospinal fluid no later than 48-72 hours from the start of treatment. If during this time there is no obvious clinical and laboratory improvement, the antibiotic treatment is changed. In newborns with purulent meningitis, antibiotics should be administered intravenously three or four times at the maximum allowable doses through a subclavian catheter.

Use antibiotics that penetrate the blood-brain barrier and have a wide spectrum of antimicrobial activity. A combined course of antibiotic therapy usually includes third-generation cephalosporins (ceftazidime, ceftriaxone) and an aminoglycoside (amikacin, netilmicin, gentamicin). All children treated by us were prescribed antibiotic therapy immediately upon admission to the hospital and included cephalosporin. After receiving the result of lumbar puncture, a second antibiotic of the aminoglycoside series was added to the combination antibiotic therapy regimen. If a second course of antibiotics was needed, when it was not possible to improve the patient's condition and normalize the cytosis parameters in the cerebrospinal fluid, the children received a second course of antibiotic therapy with meropenem and vancomycin.

The issue of hormone therapy was decided individually, taking into account the severity of the condition. In severe cases of purulent meningitis, hormonal therapy in the acute period of the disease led to an earlier disappearance of fever and intoxication, and an improvement in the condition of the newborn.

For the treatment of hypertension-hydrocephalic syndrome, dehydration was performed using furosemide. Subsequently, after the elimination of the symptoms of infectious toxicosis, in the presence of intracranial hypertension, acetazolamide was prescribed according to the scheme.

As our observations have shown, a good effect is the inclusion of immunoglobulin for intravenous administration in the treatment regimen in order to increase the body's defenses, which is especially effective in the early stages of the disease. Immediately after the diagnosis was established, all patients began intravenous administration of immunoglobulin. It was administered 2 to 5 times with obligatory laboratory control (determination of immunoglobulins G, M and A) before and after administration. More frequent administration was required by children who had a slow positive dynamics of clinical and laboratory symptoms.

Viferon in suppositories containing recombinant human leukocyte interferon alfa-2b was connected later, after improvement of clinical and laboratory parameters. It was administered at a dose of 150,000 IU 2 times a day, the duration of the course was 10 days.

Simultaneously with the start of antibiotic therapy in children, intensive infusion therapy was started through a subclavian catheter, which included the transfusion of glucose solutions, rheopolyglucin, vitamins (C, B6, cocarboxylase), furosemide, antihistamines to detoxify, improve microcirculation, and correct metabolic disorders.

Diazepam was used to relieve convulsive syndrome. Phenobarbital was prescribed for maintenance anticonvulsant therapy. Means that improve cerebral circulation (vinpocetine, cinnarizine, pentoxifylline) were also used.

The average stay of patients in the clinic was 26 days (from 14 to 48 days).

Forecast and long-term consequences

Purulent meningitis in newborns is a serious disease, the lethality of which remains high.

As our studies have shown, complex intensive therapy of purulent meningitis in newborns, started at the earliest stage of the disease, gives good results. Observation for 1-3 years of children who had purulent meningitis in the neonatal period showed that in most of them, with early detection of the disease and adequate therapy, psychomotor development corresponds to age. However, two children developed progressive hydrocephalus, four had impaired muscle tone and subcompensated hypertensive-hydrocephalic syndrome.

Children who have had purulent meningitis in the neonatal period should be observed by a pediatrician and a neurologist.

Oleg BOTVINEV, Head of the Department of Pediatrics, FPPO MMA named after. I.M. Sechenov.

Irina RAZUMOVSKAYA, Associate Professor.

Vera DORONINA, postgraduate student.

Alla SHALNEVA, head of the neonatal department, Children's Clinical Hospital No. G.N. Speransky of Moscow.

It is not the most common disease. But you should not underestimate the risk of contracting meningitis - the consequences of an infection can be very serious. How to recognize meningitis in a child?

The very idea that a child can get such a serious illness terrifies parents. And no wonder - complications after suffering inflammation of the membranes of the brain (head and spinal cord) can be not only dangerous, but also incurable.

Often parents avoid even talking about serious illnesses, apparently guided by the proverb "Don't wake up famously while it's quiet." But silence is not the best tactic when it comes to health. Meningitis, unfortunately, still affects even babies. Therefore, it is better not to hide from terrible symptoms, but to learn to distinguish them in order to be able to help your child in time. Timely diagnosis of meningitis can, without exaggeration, save a person's life!

What is the meninges?

Before proceeding to the description of the disease itself, it is worth explaining what the meninges are.

Three shells surround the human brain and spinal cord: hard (located closest to the bones of the skull), arachnoid and soft (it is adjacent directly to the brain). The space between the soft and arachnoid membrane (it is also called subarachnoid or subarachnoid) is filled with cerebrospinal fluid (CSF). The total volume of this liquid is small (from 140 to 270 ml in an adult), but it plays an extremely important role, acting as a kind of "airbag". Liquor protects the brain from mechanical influences, mitigating the effects of "shocks", and ensures the maintenance of constant intracranial pressure. Also, cerebrospinal fluid, like the meninges, supports the metabolic processes between the blood and the brain. If necessary, these "magic helpers" of our body create a barrier that prevents infections from entering the brain. Even if a person is sick with a urinary tract infection or other unpleasant illness, due to the protection of the cerebrospinal fluid and meninges, neither viruses, nor bacteria, nor any other types of pathogens will enter the brain or spinal cord.

But if this barrier is destroyed (for example, in a weakened immune system), microbes enter the meninges and attack them. As a result, a person develops meningitis, which in turn can cause various neurological complications.

The most common causative agents of bacterial meningitis are meningococci (Neisseria meningitidis), pneumococci (Streptococcus pneumoniae), and Haemophilus influenzae serotype B. The latter, fortunately - thanks to the spread of vaccination - in our time are less likely to make themselves felt.

The most important risk factor for developing meningitis is a weakened or immature immune system. That is why children - especially those who are often in crowded places (kindergartens, markets, shopping centers) - are more susceptible to the disease than adults.

Symptoms of meningitis in babies

The disease develops rapidly. Sometimes meningitis is preceded by an average or SARS. The child has a high temperature, he becomes restless and irritable, or, conversely, unusually lethargic. He reacts to touch by crying, as if his skin is irritated by something. The fontanel on the head thickens, swells and pulsates. The child may have an aversion to food up to vomiting, the occipital and posterior femoral muscles tense up. I may experience seizures. An alarming symptom is the appearance on the skin of a child (more often on the legs and trunk) of petechiae - purple dot hemorrhages of various shapes and sizes that do not disappear with pressure.

If a child has symptoms that indicate meningitis, you should immediately seek medical help: call an ambulance or go to the hospital yourself!

Diagnosis of meningitis

Since meningitis in infants can have atypical symptoms, not only the initial examination by a doctor is necessary, but also laboratory tests. In addition to a blood test, in the diagnosis of meningitis, a study of the cerebrospinal fluid is mandatory. To do this, a lumbar puncture is done: under local anesthesia, the doctor pierces the skin of the child's back with a special needle (thus getting into the subarachnoid space) and takes a sample of cerebrospinal fluid. A very small amount of cerebrospinal fluid is enough to make a diagnosis. At the same time, its appearance can already tell a lot to a specialist. If the liquid is cloudy (similar to oil), bacteria are the source of the infection; clear liquid indicates the viral nature of the disease.

The risk of complications after lumbar puncture is low, and the diagnostic value of this test is very high.