Neonatal Meningitis Differential Diagnoses

Updated: Feb 12, 2018
  • Author: Gaurav Gupta, MD, FAANS, FACS; Chief Editor: Stephen L Nelson, Jr, MD, PhD, FAACPDM, FAAN, FAAP, FANA  more...
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Diagnostic Considerations

Bacterial meningitis in neonates almost always occurs with sepsis but is difficult to distinguish clinically from sepsis alone; both present with a constellation of symptoms that indicate systemic illness. Therefore, treatment is started on the basis of presumed infection rather than proven infection. Because the goal in the neonate is to manage any life-threatening condition that will respond to intervention, the differential diagnosis includes disorders of cardiac, pulmonary, and metabolic functions.

Other central nervous system (CNS) problems may present in a manner that simulates meningitis. These include hemorrhage, ischemic stroke, and hypoxic-ischemic encephalopathy. Cerebral edema associated with nonhemorrhagic trauma may present a confounding picture.

In addition, bacterial or viral meningitis always should be considered among the disorders that cause shock, disseminated intravascular coagulation (DIC), or hepatic failure in neonates. However, by the time these conditions develop, the opportunity for successful intervention may have passed. Therefore, prompt consideration of meningitis remains prudent whenever a neonate demonstrates even slight lethargy or irritability.

Other conditions that should be considered are drug withdrawal, inborn errors of metabolism (including aminoacidopathies, organic acidurias, urea cycle disorders, and mitochondrial disease), and gastrointestinal problems such as necrotizing enterocolitis or perforated bowel. The possibility of nonaccidental trauma (ie, shaken baby syndrome) should be taken into account as well.

Differential Diagnoses