Signs and Treatments for Meningitis in Babies

Meningitis is inflammation of the meninges, which make up the three-layer lining that surrounds and protects the brain, spinal cord, and cerebrospinal fluid (CSF). Babies under age 2 are at the highest risk of getting infectious meningitis, and young babies can have serious long-term effects of meningitis.

Treatment involves close management of fevers, reduction of swelling around the brain, seizure treatment, and sometimes antimicrobial treatment to target the infection.

Prevention is important and involves vaccination and avoiding exposure by keeping the baby away from anyone who could have a contagious infection. For babies who are at risk of becoming infected with meningitis from their mothers during birth, preventative antibiotic treatment is sometimes given to the mother and/or the baby.

Causes

There are several types of infectious meningitis in babies, including bacterial, viral, and fungal infections. Bacterial meningitis is the most common type of meningitis in babies who are younger than 2 months old, and viral meningitis is more common among older babies.

These infectious pathogens often cause mild symptoms of an upper respiratory infection, such as a runny or stuffy nose, but sometimes they can cause meningitis. You might not always be able to trace back to how your baby was exposed to an infectious pathogen that caused meningitis.

Bacteria

The most common causes of bacterial meningitis among babies younger than 2 months of age are group B Streptococcus, Streptococcus pneumoniae, Listeria monocytogenes, and Escherichia coli.

Older babies are more likely to become infected with Streptococcus pneumoniae, Neisseria meningitidis, Haemophilus influenzae type b (Hib), and group B Streptococcus.

Tuberculosis (TB) is an infection caused by Mycobacterium tuberculosis that can cause severe and rapidly worsening meningitis, especially for young children. It is more common in certain regions of the world, including African and Asian countries, and usually causes a lung infection.

TB meningitis is a severe complication of the infection and causes a high risk of death or serious lasting neurological damage.

Viruses

Babies can get viral meningitis infections, which are not usually as severe as bacterial meningitis. However, babies can have lasting consequences after recovery from viral meningitis, and the infection is more severe for young children than it is for adults.

Causes of viral meningitis in babies include measles virus, varicella zoster virus, influenza virus, Epstein-Barr virus, and mumps virus.

Fungus

Fungal meningitis is not common in babies, but the most common cause is Candida, followed by histoplasmosis. These infections can be severe and are associated with systemic infections and sepsis.

Risk Factors

Meningitis is not as common as respiratory or gastrointestinal infections because the nervous system is less susceptible to infections due to the protective blood-brain barrier. However, babies are at an increased risk because they have a relatively less developed immune system than older children or adults.

Young babies also have not received many of their immunizations yet, leaving them at risk of getting infections that older children have been protected from due to vaccination. 

Additionally, neonates (defined as less than 4 weeks old) have increased exposure to certain infections during birth. Some organisms, including Group B Streptococcus and Candida, can be present in the mother’s birth canal without causing any infection or adverse effect for the mother.

Other factors, such as having to stay in the hospital for a medical reason, can expose a baby to potential infections. A penetrating head trauma would also increase the risk of contamination that could cause meningitis.

Symptoms

Newborns, older babies, and young children up to age 2 do not have the same meningitis symptoms as older children or adults. Babies can have symptoms of meningitis that are the same as symptoms of any other illness and are not easy for new parents to recognize.

Symptoms can include persistent crying, unusual irritability, or excessive sleeping. Because they are so young and cannot express themselves, babies who exhibit these symptoms should get prompt medical attention. 

Signs and symptoms that your baby might display with meningitis include:

• Fevers 
• Sleeping more than usual 
• Not being able to get to sleep
• Lack of appetite
• Vomiting
• Diarrhea 
• Skin rash, especially with Neisseria meningitidis
• Decreased responsiveness 
• Diminished interest in looking around 
• Decreased reaction to sounds or acting like they aren’t hearing noises around them 
• Rigid neck 
• Spastic movements 
• Stiff or rigid extremities 
• Preferentially turning the neck to one side without a reason 
• Full fontanelles (soft spot on the scalp looks puffed or different than usual)
• Seizures 
• Loss of milestones that had already been attained
• Weakness or floppiness of an arm, leg, or one side of the body

The more of these effects a child has, the more likely they are to have meningitis or another type of infection. 

Diagnosis

You should get medical attention for your baby if you have any concerns about meningitis or any other serious infection. Your child’s healthcare professional will do a physical examination. This will include assessing their level of alertness, muscle tone, and response to sounds and visual stimuli.

The fontanelles, which can be full or tense due to meningitis, are inspected. Head circumference is measured, as a smaller or larger than expected head size can indicate meningitis or other brain disorders in young children. 

Additionally, your child’s healthcare professional will examine their eyes and eye movements, as well as their pupils and the pupillary response to light.

Reflexes will be checked—young babies often have special reflexes, described as primitive reflexes or newborn reflexes, that normally disappear within the first few years of life.

For example, babies may have a palmar grasp reflex, in which they grab tightly to any object placed in their palm. Changes in these reflexes are very important in identifying nervous system disease in young babies. 

Further tests may be needed to determine whether your baby has an infection, whether the infection is meningitis, the type of meningitis, and the extent of brain or spine involvement. 

Tests and Labs 

A number of diagnostic tests can be helpful in the diagnosis of meningitis in babies. Your child’s doctor may obtain a complete blood count (CBC), which can show signs of infection, including an elevated white blood count (WBC).

A blood chemistry test can show alterations of electrolytes that may indicate dehydration, and a urine test or blood culture may identify an organism causing meningitis if it is also present in the blood or urine.

Lumbar Puncture

A lumbar puncture (spinal tap) is used to identify an infectious organism causing meningitis. It is an invasive test involving the collection of CSF with a needle inserted below the spine.

The fluid is sent to a laboratory for analysis. It may show signs of inflammation, and/or it may identify an infectious organism in the CSF. Sometimes, however, an infectious organism might not be detected, even when there is an infection.

The procedure should take about 10 to 15 minutes if it is done at the bedside. However, it can take longer if it is done with sedation and imaging guidance.

A lumbar puncture might not be recommended if the baby does not have substantial abnormalities on their neurological examination. However, if your baby’s condition worsens or is not improving with treatment, this test might be necessary.

Depending on the baby’s symptoms and physical examination findings, a brain imaging study may be indicated before a lumbar puncture. Certain problems, such as obstruction of CSF or a brain tumor, can make a lumbar puncture dangerous. The imaging study would help to identify these or rule them out.

Imaging 

Brain imaging studies, such as computerized tomography (CT), magnetic resonance imaging (MRI), or brain ultrasound, can be useful in assessing possible meningitis.

These tests can show obstruction, masses, anatomical defects, or fluid accumulation in the brain. A brain or spine MRI might also show evidence of meningeal inflammation that may occur with meningitis.

Brain imaging tests can be difficult to obtain for young children, who may need sedation to be still during the test for adequate image results.

Treatment

The treatment of meningitis in babies is focused on comfort and the prevention of long-term complications. Treatment is tailored to controlling symptoms and, in some cases, to treating the infectious pathogen.

Supportive care to maintain nutrition and respiration (breathing) may be necessary in some cases. 

Treatment can include:

Antimicrobial medication: Generally, viral meningitis is often not treated with antimicrobial treatment, as it typically resolves on its own. However, bacterial meningitis and fungal meningitis must be treated with medication that targets the infection.

Sometimes antibiotics are started before the infection is identified and might be changed depending on the lumbar puncture results.

Antibiotics often used to treat bacterial meningitis include ceftriaxone, cefotaxime, ampicillin with gentamicin or cefotaxime, azithromycin, amoxicillin, cefixime, amoxicillin/clavulanate, or trimethoprim/sulfamethoxazole.

Fever control: A high fever can make a baby lethargic, and it can also lead to seizures for some babies. For these reasons, management of the baby’s body temperature may be necessary. 

Treating hypothermia: Sometimes, babies with meningitis can have a low body temperature. In these instances, the baby may need to be slightly warmed with a blanket or a warming bed. 

Fluid management: A baby who has meningitis can become dehydrated or may have excess fluid around the brain. Sometimes, management of body fluid concentration is needed with intravenous fluids or medication.

Nutrition: Babies who have meningitis often have a decreased appetite and/or might experience vomiting. Nutritional supplementation might be necessary to maintain weight and have a healthy immune system to fight off the infection.

Oxygen supplementation: Sometimes, a baby’s oxygen level can be reduced due to meningitis, and non-invasive oxygen supplementation with a nasal cannula can be helpful.  

Seizure control: Babies can have seizures during a meningitis infection. This can occur due to irritation around the brain, as well as due to fevers. Anti-epileptic drugs (AEDs) can help control seizures during this time.

Steroids; Sometimes steroids are used to reduce inflammation. However, these medications suppress the immune system and can worsen infections, so the advantages and disadvantages of their use are very carefully considered in the treatment of meningitis.

Treatment of hydrocephalus: Fluid buildup in the brain can be treated with medication, such as diuretics. However, sometimes medication is not adequate to reduce fluid pressure on the brain, or an obstruction of CSF flow can develop due to inflammation or the infection.

In these instances, a procedure may be needed to remove the fluid, and possibly a ventricular shunt might need to be placed. 

Respiratory support: In severe cases, breathing can be impaired, and a baby may need mechanical respiratory assistance until they can breathe on their own again.

Prevention 

There are several measures that can help prevent meningitis in babies. Pregnant people may be screened for infections. If a baby is at risk due to a maternal infection, antibiotics may be given.

If the infection is discovered before the baby is born, the mother may be treated, and possibly the baby as well. If the maternal infection is discovered after the baby is born, the baby will often be treated.

Additionally, it is important to make sure that your baby receives the vaccines that are recommended for their age.

Avoiding exposure to infections is also crucial. Don’t let anyone who has an infection touch your baby or get near your baby. Maintain hygiene, such as hand washing before you touch your baby and before you touch their food. Be sure that fresh food is washed thoroughly before your baby eats it.

Complications 

Meningitis can cause complications and lasting effects. This may happen if the infection becomes severe. Early treatment reduces the risk of complications, but sometimes the condition can progress even with prompt and comprehensive treatment. 

Complications of meningitis in babies can include:

Hearing loss: Babies who recover from meningitis can have nerve damage that affects hearing in one or both ears. This can occur after any type of infectious meningitis, and it is specifically associated with viral meningitis, such as that caused by the varicella zoster virus. 

Seizures: Seizure episodes can resolve after the acute phase of the infection, or a child may develop epilepsy after recovering from meningitis. This is more common with bacterial meningitis and with meningitis that involved very high fevers.

Hydrocephalus: Babies who develop hydrocephalus and/or CSF obstruction due to meningitis might remain susceptible to hydrocephalus after the infection resolves. This may necessitate surgery and/or prolonged placement of a ventricular shunt.

Cognitive deficits: Sometimes meningitis is associated with low oxygen levels during the infection or may lead to encephalitis (brain inflammation), often described as meningoencephalitis. These problems can cause harm to the brain that lasts after the infection resolves and may impair cognitive functions later in life.

Vision impairment: Meningitis can affect the areas of the brain that affect vision, potentially resulting in lasting visual defects.

Motor deficits: Damage to the areas of the brain or spine that control movement can occur with severe meningoencephalitis and might result in lasting problems with motor control.

Limb loss: Neisseria meningitidis and other types of bacterial meningitis can cause severe systemic inflammation in the body, potentially leading to blood clots that could result in limb loss. 

Prognosis

The prognosis for meningitis depends on the cause and the severity of the infection. Usually, viral meningitis can resolve without complications or long-term problems.

Bacterial and fungal meningitis are more likely to produce lasting side effects, although these can also fully resolve without complications. Generally, the sooner treatment is started, the more likely your child will have a good outcome.

A Word From Verywell

Meningitis can affect people of all ages, but babies are more susceptible to infectious meningitis. While you can take steps to try to prevent your baby from getting meningitis, it is not possible to ensure that prevention will be 100% effective.

If you are concerned about your baby’s symptoms, talk to their doctor or seek medical attention promptly. A diagnosis of meningitis can take some time, and it may take days or longer for treatment to resolve the infection.

After your baby recovers from meningitis, you can work with their pediatrician to identify any signs of lasting complications so they can be addressed as effectively as possible.