Consequences of purulent meningitis in newborns. Meningitis in children: symptoms and first signs

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

It can result in death or disabling complications (hydrocephalus, blindness, deafness, spastic paresis and paralysis, epilepsy, delayed psychomotor development up to mental retardation). The outcome depends on timely initiation of intensive treatment. Etiology and pathogenesis.

According to 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 mother's genitourinary tract; infection can also occur from the patient or from a carrier pathogenic microflora. The development of meningitis is usually preceded by hematogenous spread of infection. Microorganisms overcome the blood-brain barrier and penetrate the central nervous system. Predisposing factors include infections genitourinary tract mothers, chorioamnionitis, long anhydrous period (over 2 hours), intrauterine infection, prematurity, intrauterine malnutrition of the fetus and its morphofunctional immaturity, asphyxia of the fetus and newborn, intracranial birth injury and related therapeutic measures, malformations of the central nervous system and other situations when it has place a decrease in immunological protective factors. The penetration of a bacterial infection into the child’s bloodstream is facilitated by inflammatory changes in the mucous membrane of the nose and pharynx during an acute respiratory viral infection, which, according to our observations, often accompanies the onset of purulent meningitis.

Meningitis is now often caused by Streptococcus agalactiae (group B beta-hemolytic streptococcus) and Escherichia coli. The meningococcal etiology of purulent meningitis in newborns is now rarely observed, which is apparently explained by the passage of immunoglobulin G, containing antibodies to meningococcus, through the mother's placenta to the fetus. Intrauterine meningitis, as a rule, clinically manifests itself in the first 48-72 hours after birth, postnatal meningitis manifests itself later. According to our data, such children were admitted to the clinic on the 20-22nd day of life, when there is a decrease in the content of immunoglobulin G received from the mother in the newborn’s blood serum. By this time, maternal immunoglobulin G is catabolized and its level in the blood decreases by 2 times.

Postnatal meningitis can also develop in intensive care units and intensive care and in departments for nursing premature babies. Their main pathogens are Klebsiella spp., Staphylococcus aureus, P. aeroginosae and fungi of the genus Candida. As our observations showed, the mothers' medical history included risk factors such as threatened miscarriage, infection urinary system, the presence of chronic foci of infection in pregnant women (tonsillitis, sinusitis, adnexitis, vaginal thrush), as well as a long anhydrous period during labor (from 7 to 28 hours).

Despite the variety of pathogens causing purulent meningitis in newborns, morphological changes The central nervous system is similar. They are localized mainly in the soft and arachnoid membranes. Removal of exudate occurs by phagocytosis of fibrin and necrotic cells by macrophages. In some, it undergoes organization, which is accompanied by the development of adhesions. Impaired patency of the cerebrospinal fluid pathways can lead to the development of occlusive hydrocephalus. Reparation may take 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 the hospital, since clear clinical manifestations develop later, and at first nonspecific symptoms are observed, similar to many infectious and inflammatory diseases (pallor, marbling, cyanosis of the skin, conjugation jaundice, hyperesthesia , vomit). Some children experience an increase in temperature to low-grade levels. Symptoms of the disease develop gradually. The child's condition is progressively deteriorating. The temperature rises to 38.5-39°C. Upon examination skin pale, sometimes with a grayish tint, acrocyanosis and marbling are often observed, sometimes in children conjugation jaundice is pronounced. There are violations from respiratory system- decrease in respiratory rate, attacks of apnea, and bradycardia is characteristic of the cardiovascular system. Patients also have hepato- and splenomegaly.

In the neurological status of some newborns, signs of central nervous system depression are observed: lethargy, drowsiness, adynamia, decreased physiological reflexes, muscle hypotension. Others experience symptoms of central nervous system excitation: motor restlessness, hyperesthesia, painful and high-pitched cry, tremor of the chin and limbs, foot clonus. Disorders of the cranial nerves can manifest themselves in the form of nystagmus, floating movements of the eyeballs, strabismus, and the “setting sun” symptom. Some babies experience regurgitation and repeated vomiting, weak sucking, or refusal of the breast and pacifier. A sick child does not gain weight well. At a later stage, tilting of the head back and meningeal symptoms (tension and bulging of the large fontanel, rigidity of the muscles of the back of the neck) appear. A typical position is for a child to lie on his side with his head thrown back, legs bent and pressed to his stomach. Meningeal symptoms, typical for older children (Kernig, Brudzinsky), are uncharacteristic for newborns. Sometimes a positive Lessage symptom is observed: the child is lifted up by holding the armpits, and at this time his legs are in a flexed position. Polymorphic convulsions and paresis may be observed cranial nerves, changes in muscle tone. The cause of the development of seizures is hypoxia, microcirculatory disorders, cerebral edema, and sometimes hemorrhagic manifestations. In some cases, there is a rapidly progressive increase in head circumference and divergence of cranial sutures due to intracranial hypertension.

An analysis of the medical records 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 ( average age- 23 days). When referred to the hospital, purulent meningitis was suspected in only 2 children; in the rest, the referring diagnosis was ARVI, enterocolitis, conjugative jaundice, intrauterine infection, urinary tract infection, osteomyelitis. On admission, the majority of newborns did not have clear and characteristic signs of meningitis. However, anamnestic data and serious condition allowed us to believe that the disease began earlier, which was confirmed by studies of cerebrospinal fluid. Upon admission, most children had an increase in temperature to 38-39.6 ° C. As a rule, there were no pronounced catarrhal symptoms. In some children, the clinical picture showed manifestations of local purulent infection (purulent conjunctivitis, omphalitis, urinary tract infection).

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 band neutrophils up to the appearance of juvenile 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 and 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 full-blown clinical picture. 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 for purulent meningitis in newborns, cerebrospinal fluid often flows out under pressure, is cloudy, and sometimes, with large cytosis, yellow in color and thick. Shock and disseminated intravascular coagulation are contraindications to lumbar puncture.

In our observations, almost all admitted children were diagnosed on the first day of hospital stay. 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, and less commonly, hyperesthesia. In the cerebrospinal fluid there was an increase in the content of leukocytes with a predominance of the neutrophilic component (more than 60%).

With purulent meningitis, the content of total protein in the cerebrospinal fluid increases later than the increase in neutrophilic pleocytosis. 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, protein concentration ranged from 0.33 0/00 to 9 0/00. Increased content protein in the cerebrospinal fluid obtained during the first puncture was found in 10 patients, which indicated a certain duration of the disease. Characteristic of purulent meningitis low level 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 culture of the cerebrospinal fluid and smear bacterioscopy in most cases did not reveal the pathogen. Group B beta-hemolytic streptococcus was detected in two patients, Haemophilus influenzae was cultured in one, and pneumococcus was cultured in one.

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

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

Neurosonography allows you to diagnose ventriculitis, dilation of the ventricular system, the development of a brain abscess, as well as identify severe concomitant intracranial hemorrhages, ischemic infarctions, and developmental defects.

Computed tomography is indicated to exclude brain abscess, subdural effusion, as well as to identify areas of thrombosis, infarction and hemorrhage in brain structures.

Complications

Most common early complications are edema and swelling of the brain and convulsive syndrome.

Clinically, cerebral edema is manifested by increasing intracranial hypertension. During this period, the newborn's posture with his head thrown back is characteristic; there is a monotonous, at times piercing, cry, sometimes turning into a groan. Possible bulging of the large fontanel, its pulsation, and separation of the cranial sutures. Brain edema can be clinically manifested by dysfunction of the oculomotor, facial, trigeminal and hypoglossal nerves. Coma is clinically manifested by inhibition of all types of cerebral activity: adynamia, areflexia and diffuse muscle hypotonia. Further, the pupillary response to light disappears, apnea attacks become more frequent, and bradycardia develops.

With purulent meningitis, convulsive syndrome often develops. Initially, the seizures 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 penetration into the bloodstream large quantity bacterial endotoxins. Clinically septic shock manifests itself as sudden cyanosis of the extremities, a catastrophic decrease in blood pressure, tachycardia, shortness of breath, weak moaning cry, loss of consciousness, often in combination with disseminated intravascular coagulation syndrome. 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 hospital stay from infectious-toxic shock complicated by disseminated intravascular coagulation. The second girl, 17 days old, died on the 2nd day after admission. She had intrauterine generalized cytomegalovirus infection and purulent meningitis developed. Severe consequences of purulent meningitis can include hydrocephalus, blindness, deafness, spastic paresis and paralysis, mental retardation, and epilepsy.

Differential diagnosis

Neurological symptoms similar to purulent meningitis can be observed in the presence of intracranial hemorrhage in a newborn. Such children also experience motor restlessness, tremor of the chin and limbs, nystagmus, strabismus, and the “setting sun” symptom. To exclude purulent meningitis, it is necessary to carry out spinal tap. Intraventricular hemorrhage is characterized by the presence in the cerebrospinal fluid of a large number of altered red blood cells, as well as increased concentration 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 differential diagnosis with pyloric stenosis, in which “fountain” vomiting is observed without fever and inflammatory changes in the blood test. Often, when examining the abdomen, a positive hourglass sign is noted. The main methods for diagnosing pyloric stenosis are esophagogastroduodenoscopy and ultrasound.

Symptoms of central excitation nervous system(restlessness, tremor of the limbs and chin, hyperesthesia), similar to purulent meningitis, can be observed with influenza and ARVI. 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 a spinal puncture, the fluid is clear and colorless and flows out under high blood pressure, often in a stream, 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 of influenza and ARVI do not disappear, or, moreover, increase, repeated diagnostic spinal punctures are necessary.

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

Treatment

Newborns with purulent meningitis require complex treatment, including antibacterial, infusion therapy, and immunoglobulin replacement therapy for intravenous administration. If necessary, hormonal, anticonvulsant, and dehydration therapy is carried out. Such children require the most gentle regimen. IN acute period They are not recommended to be breastfed. They get expressed mother's milk, or, if the mother does not have it, formula from a bottle. When the sucking reflex is suppressed, feeding the child through a tube is used.

Causal antibacterial therapy is the main method of treating 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 has not been found, the effectiveness of antibacterial therapy is assessed based on clinical data and the results of a repeat 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 antibacterial treatment is changed. In newborns with purulent meningitis, antibiotics should be administered intravenously three or four times in the maximum allowable doses through a subclavian catheter.

Antibiotics are used that penetrate the blood-brain barrier and have a wide spectrum of antimicrobial action. Combined course antibacterial therapy usually includes third generation cephalosporins (ceftazidime, ceftriaxone) and an aminoglycoside (amikacin, netilmicin, gentamicin). All children we treated were prescribed antibacterial therapy immediately upon admission to the hospital and included a cephalosporin. After receiving the result of the lumbar puncture, a second aminoglycoside antibiotic was added to the combination antibacterial therapy regimen. If a second course of antibiotics was necessary, when it was not possible to achieve improvement in the patient's condition and normalization of cytosis in the cerebrospinal fluid, the children received a second course of antibacterial therapy with meropenem and vancomycin.

Question about conducting 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.

To treat hypertensive-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 regimen.

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

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

Simultaneously with the start of antibacterial therapy in children, intensive infusion therapy through a subclavian catheter, including transfusion of solutions of glucose, rheopolyglucin, vitamins (C, B6, cocarboxylase), furosemide, antihistamines for the purpose of detoxification, improvement of microcirculation, correction of metabolic disorders.

For cupping convulsive syndrome diazepam was used. Phenobarbital was prescribed for maintenance anticonvulsant therapy. Drugs 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).

Prognosis and long-term consequences

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

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

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

Oleg BOTVINYEV, Head of the Department of Pediatrics, Faculty of Postgraduate Education, MMA named after. I.M. Sechenov.

Irina RAZUMOVSKAYA, associate professor.

Vera DORONINA, graduate student.

Alla SHALNEVA, head of the neonatal department of Children's City Clinical Hospital No. 9 named after. G.N. Speransky Moscow.

Most meningitis are infectious forms that 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 registered in 70-80% of cases in patients with this disease.

Meningitis in bacterial form is serious and can develop into purulent forms. In most cases in infants and infants Streptococcal and meningococcal forms of meningitis are detected; these infections often lead to serious complications and are severe.

Serous meningitis is overwhelmingly caused by viruses. These are mainly pathogens that cause rubella and chickenpox. Weakened children are very susceptible to influenza infection. Problems at work are often recorded immune system, immunodeficiency is observed. Children with diabetes or who have been using glucocorticosteroids since birth may develop candidal meningitis.

This disease develops quickly in weak children's body. The harmful candida fungus, which causes candidal meningitis, enters the meninges along with the blood, after which it begins to multiply there, causing severe inflammation. This type meningitis takes much longer to treat than bacterial meningitis.

The rarest type of meningococcal infection in newborns is the tuberculosis variant, which is caused by protozoan microorganisms. This form of the disease is observed in only 2-3% of cases.

When a birth injury occurs, a traumatic form may occur, which is characterized by a severe form. Patients with this form of meningitis should receive recommendations from a neurosurgeon and undergo regular monitoring by a neurologist.

Examination methods

Extracting 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;
• blood clotting process;
• presence of bacteria.

The examination is based on the results obtained from methods associated with the isolation of microorganism cultures from cultures of cerebrospinal fluid and blood. They can be positive in more than 80% of patients who have not been exposed to antibiotic therapy. This type therapy contributes to negative cultures due to accumulation of pus in the brain, which can be caused by special bacteria, enterovirus herpes.

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

To make a diagnosis of meningitis, it is necessary to cellular composition cerebrospinal fluid leukocytes exceeded 21 cells per 1 mm3. Microscopic examination of cells obtained from a source of pathology and diagnosis of diseases leading to metabolic disorders may not give the desired result.

Glucose concentration in cerebrospinal fluid in a newborn baby ahead of schedule- from 55 to 105%, compared with the blood glucose level of a person 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;
• availability bacterial disease, which manifests itself in patches purulent inflammation, which is confirmed by data from clinical and laboratory studies;
• the condition worsens markedly when antimicrobial drugs 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 lumbar level may be postponed until the patient’s condition normalizes, despite the delay in accurate diagnosis, as well as the likelihood of taking medications incorrectly.

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

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

Meningitis with CSF values ​​within normal limits 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 may be on the border between normal and abnormal. In this case, it is necessary to examine 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. Moreover, 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. Equally important when 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 the culture of the cerebrospinal fluid, and therefore a detailed diagnosis of the CSF is necessary. Extraction of cerebrospinal fluid using a special needle, which constantly circulates in the ventricles of the brain, is necessary if meningitis is not revealed during clinical and microbiological studies.

Treatment

High-quality relief from the disease directly depends on the cause of its occurrence, namely: the pathogen. Meningitis purulent type occurs from bacterial, fungal or viral infection. Treatment uses methods that are aimed at eliminating the pathogen.

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

Treatment courses consist of injections of antibiotics, antiviral or antifungal medications. Medicines are administered in significant volumes until the symptoms of the disease completely disappear. To confirm complete recovery, a repeat examination of the cerebrospinal fluid is required.

Negative consequences of the disease

Including when timely diagnosis diseases, 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.
• Lag from age standards 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 disease development in premature babies therapeutic measures do not have the desired effect on the body and the situation ends in death.

In children age group up to 1 year there is a risk of viral meningitis as a complication after acute respiratory viral infection, influenza, various diseases. Weakened and frequently ill children may develop serous type diseases. Fungal meningitis caused by candidiasis also often occurs.

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

• intoxication of the body;
• diarrhea;
• nausea and vomiting;
• increased body temperature;
• causeless crying of a child.

You can often begin to suspect an inflammatory process in the meninges when the baby screams in bright light and loud sound. Thus, pain in the head manifests itself during meningitis. In this condition, the lack of urgent medical attention can only worsen the situation, such as seizures.

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

In children over 2 years of age, the causes of meningitis can be:

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

It often occurs after contact with stray animals that carry viruses, or with a sick person. Most of 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 reasons that cause inflammatory processes in the meninges, is . This type of meningitis occurs in the vast majority of cases, while 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 infections. Data diseases are difficult to cure and have high risk occurrence of complications. Serous meningitis is always caused by viruses entering the body.

The causative agent of the disease can be rubella virus, smallpox virus, etc. The influenza form is often observed in children with poor health. Often, such children exhibit disturbances in the functioning of the immune system. People diagnosed with diabetes may develop candidal meningitis, which, along with the flow of bacteria, can enter the meninges, where it causes severe inflammation.

This disease takes much longer to treat than. Doctors rarely detect the tuberculosis form. This species occurs in 2-3% of total number sick with this type of infection. The traumatic form can occur due to 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 examination by a neurologist and neurosurgeon.

Meningitis is called acute inflammation membranes of the brain and spinal cord. This disease is caused by an infection entering the body. Quite often, this disease occurs in children, since their immunity is not yet strong enough. Meningitis also occurs in newborns. Boys are more likely to suffer from this disease than girls. According to the latest statistical studies, two full-term babies out of every 10 thousand suffer from meningitis. Babies born at low birth weight or prematurely are more likely to have this condition. It appears in 2 babies out of 1000.

Symptoms of the disease

The disease is considered very dangerous, because it can be fatal. Therefore, it is necessary to start therapy immediately after the first symptoms appear. The most common signs of meningitis in newborns include:

• increase or decrease in body temperature;
• difficulty breathing;
• irritability;
• drowsiness;
• repeated vomiting;
• limb spasms.

These symptoms are often confused with signs of acute respiratory diseases, which complicates diagnosis. A child in this condition should be urgently shown to a specialist. The disease can be recognized by an enlarged fontanel in a newborn. This symptom occurs in 25% of babies. It is associated with increased pressure in the brain.

In addition, some children may experience spasms facial muscles. With meningitis in newborns, abscesses form in the brain. With their development, the intracranial pressure. This causes the baby's head to become larger. As the disease progresses, symptoms become more pronounced. If the child is not immediately shown to a doctor, an abscess may rupture.

Lit.: Big medical encyclopedia 1956

The disease is caused by various harmful bacteria, fungi and viruses that have penetrated the weakened body of the baby. The main causative agents of meningitis include:

However, most often, in almost 70% of reported cases, meningitis in newborns is caused by the meningococcal bacterium. You can get infected with it in various ways. Distributors can be people and sick animals. Infection occurs:

• by contact;
• airborne;
• through the bloodstream;
• along the lymphatic tract;
• from the mother through the placenta.

Because protective forces Since the newborn's immunity is not functioning well, infection occurs quite quickly. Trying to deal with the problem on your own is strictly prohibited. Such actions may lead to dangerous complications. Refusal of treatment may threaten the child with toxic shock, cerebral edema, and acute adrenal failure. Such consequences often cause fatal outcome.

If newborns are diagnosed, they are sent to the infectious diseases department. Treatment is carried out only in a hospital setting. The following specialists can help you cope with the disease:

At the first appointment, the doctor will carefully examine the child. After this, he will ask the parents several clarifying questions:

1. How long ago did the first symptoms appear?
2. How was the birth? Were there any complications?
3. Has the child had contact with sick people?
4. Was he sick with anything?

The information received from parents will help the specialist quickly determine the cause of the disease. The baby is hospitalized and prescribed diagnostic procedures. The newborn will definitely undergo a cerebrospinal fluid puncture and undergo various laboratory tests.

Modern medicine is able to eliminate or stop most existing pathological processes. For this purpose, countless medications, physiotherapeutic procedures, etc. have been created. However, many therapy methods are most effective in the early stages of the disease. Among such pathological processes, meningeal syndrome can be distinguished. It is a complex of manifestations characteristic of irritation of the meninges. Among its causes are meningitis, meningism and pseudomeningeal syndrome. The last type is a consequence mental disorders, pathologies of the spine, etc. Inflammation of the meninges is characteristic only of the first 2 types, so it is recommended to find out what meningeal symptoms exist in order to identify the problem in time and begin treatment.

Meningeal syndrome, regardless of the cause, is expressed by certain symptoms. The first signs of the disease look like this:

• Feeling of aching throughout the body, as if you have a cold;
• General lethargy and fast fatiguability even after sleep;
• Increased heart rate;
• Disturbances in the respiratory system;
• Temperature rise above 39º.

Gradually, meningeal symptoms (signs) appear more and more intensely and new ones are added to the previous signs:

• Manifestation of convulsive attacks. This symptom occurs mainly in children. For adults, its occurrence is considered rare;
• Adopting a meningeal position;
• Development of abnormal reflexes;
• The occurrence of a headache. This symptom is the main one and manifests itself extremely intensely. The pain intensifies mainly due to external stimuli, for example, light, vibration, sound, sudden movements etc. The nature of the pain is usually acute and it can radiate to other parts of the body (neck, arms, back);
• Vomiting due to severe headache;
• Development of hypersensitivity (hyperesthesia) to light, vibration, touch, sounds, etc.
• Rigidity (petrification) of the muscle tissue of the back of the head.

The combination of these symptoms represents meningeal syndrome. The degree of manifestation and combination of symptoms may be different, since this pathological process has many causes. The presence of pathology is determined primarily using instrumental examination ( lumbar puncture, MRI, etc.), but initially you should pay attention to its main manifestations.

Main features

During the examination, the doctor focuses on the following signs:

• Bekhterev's symptom. It is determined by easy tapping on cheekbones. At the same time, the patient begins to have an attack of headache and facial expressions change;
• Brudzinski's sign. It is divided into 3 types:
  • Top form. If you put the patient on the couch and ask him to stretch his head to his chest, then along with this movement his legs will involuntarily bend in knee joint;
  • Zygomatic shape. This sign is actually similar to Bekhterev's symptom;
  • Pubic shape. If you press on the pubic area, the patient will reflexively bend the lower limbs at the knee joint.
• Fanconi's sign. A person is not able to sit down independently if he is in a lying position (with his knees bent or fixed);
• Knik's sign. To check for this sign, the doctor applies light pressure around the corner. lower jaw. With meningeal syndrome, this action causes acute pain;
• Gillen's sign. The doctor checks this sign of meningeal syndrome by squeezing the quadriceps muscle on the front surface of the thigh. At the same time, the patient contracts the same muscle on the other leg.

Among other symptoms characteristic of inflammation of the meninges, two main manifestations of the pathological process described by Klunekamf can be distinguished.

The essence of the first sign is that the patient, when trying to stretch his knee to his stomach, experiences pain that radiates into the sacral region. A feature of the second symptom is pain when pressing on the atlanto-occipital membrane.

Kernig's symptom is considered one of the first manifestations of the pathological process. Its essence lies in the inability to independently straighten lower limb, if it is bent at an angle of 90º at the hip and knee joint. In children, such a meningeal sign may not appear at all. In infants up to 6-8 weeks and in children suffering from Parkinson's disease or myotonia, Kernig's sign is a consequence of excessively high muscle tone.

Hardening of the neck muscles

The muscle tissue located in the back of the head begins to harden with meningeal syndrome. This problem arises due to an abnormal increase in their tone. The occipital muscles are responsible for straightening the head, so the patient, due to its rigidity, cannot calmly bend his head, since along with this movement the upper half of the body is arched.

For people suffering from meningeal syndrome, a certain position is characteristic, in which the intensity of pain decreases:

• Pressed to chest hands;
• Body arched forward;
• Intracted abdomen;
• Head thrown back;
• Lower limbs raised closer to the stomach.

Features of symptoms in children

In children, meningeal manifestations are predominantly a consequence of meningitis. One of the main signs of the disease is Lesage's symptom. If you press on the baby's armpits, his legs reflexively rise towards his stomach, and his head is thrown back a little. An equally important manifestation is Flatau's symptom. If the child tilts his head forward too quickly, his pupils will dilate.

The most characteristic sign of meningeal syndrome is a swollen fontanelle (the area between the parietal and frontal bone). Other symptoms may be less pronounced or absent. Common symptoms include seizures, vomiting, elevated temperature, weakening of the muscles of the limbs (paresis), moodiness, irritability, etc.

In newborns, meningitis occurs as follows:

• Initially, the pathological process manifests itself with signs characteristic of a cold and poisoning (fever, vomiting, etc.);
• Gradually, children's appetite worsens. They become lethargic, moody and a little inhibited.

In the first days of development of the pathology, symptoms may be mild or completely absent. Over time, the child’s condition will worsen and neurotoxicosis with its characteristic neurological symptoms will appear.

Meningeal signs depend on the cause of the disease, but in general they are virtually the same. In most cases, the symptoms manifest themselves extremely intensely, but people, not knowing about the possible pathological process They don’t go to the doctor until the last minute. In such a situation, the consequences are often irreversible, and in the case of a child, he may even die. That is why it is extremely important to know how the disease manifests itself in order to begin a course of treatment in a timely manner.

Inflammation of the meninges in infants is rare (about 5 cases per 100 thousand newborns). The disease is a cause of infant mortality. According to statistics, the mortality rate from meningitis is up to 48% of sick newborns. To prevent tragedy, it is necessary to identify the pathology in time and begin treatment.

Features of meningitis in newborns

Damage to the meninges in infants develops as independent disease. The main cause of the disease is brain infection in newborns. In children, the disease is severe. Characteristic:

• lightning current;
• onset, as with ARVI;
• heat and vomiting;
• sometimes absence of meningeal symptoms.

Forms and causes of meningitis

By nature, brain inflammation in newborns can be purulent or serous. The reason for the first is bacterial infection. Serous meningitis of newborns occurs after penetration of the virus. Less common fungal species inflammation of the meninges. It appears in children with weak immune systems. Doctors identify risk groups for the occurrence of the disease:

• Injuries during childbirth. Damage to the membranes of the brain or nerve trunks during expulsion of the fetus.
• Low birth weight or premature babies. Their immune and nervous systems have not yet developed. Harmful microorganisms easily penetrate meninges.
• Acquired or congenital immunodeficiency. There is danger severe course any, even mild, infection.
• Chronic diseases, operations. The weakened body of newborns is not able to cope with meningococcal infection.

Serous

This form of the disease is mainly caused by viruses (cytomegalovirus, herpes, Epshein-Barr and others). In children with low immunity, inflammation of the brain can be caused by influenza or enterovirus infection. Rarely, serous meningitis in children is of a bacterial or fungal nature. The disease is transmitted from person to person by air, water, household or intrauterine means.

Incubation period– 5-7 days.

Purulent

The causative agents of this form of the disease are pathogenic bacteria. In 70% of cases, purulent meningitis is caused by meningococcal infection. This type of inflammation is characterized by the development severe complications. Reactive ones are especially dangerous. Its incubation period can last several minutes.

The reactive form of the disease begins suddenly, is acute, and for children is extremely poor prognosis.

Purulent meningitis in newborns is transmitted through air, water and food from the mother. The incubation period lasts from 2 to 5 days. The purulent form of the disease in newborns develops due to factors such as:

• prematurity;
• birth injury;
• sepsis.

Candida

In an organism with weak immunity, the opportunistic fungus Candida quickly spreads. If it enters the membranes of the brain with the bloodstream, it causes severe inflammation– candidal meningitis. Children with diabetes mellitus or babies who are prescribed steroid hormones from birth.

The incubation period of the disease is 5-7 days.

Signs of meningitis in children

At an early stage of the disease clinical picture presented with nonspecific symptoms. It is difficult to recognize meningitis in an infant, since general lethargy, drowsiness and high body temperature (up to 39°C) occur with many pathologies. The newborn refuses breast milk, he is decreasing physical activity, limbs twitch convulsively.

In later stages, meningitis manifests itself as neurological syndromes.

Nonspecific symptoms

The initial manifestations of the disease are nonspecific for all children. The first signs of meningitis in babies under one year of age:

• incessant high-pitched crying;
• unnatural pale skin;
• intolerance loud sounds, bright light;
• skin rash;
• change in breathing rhythm.

Signs of later stages

Meningeal symptoms late stages diseases:

• Brudzinsky. When the doctor tries to bring his chin closer to the chest of a sick baby, there is resistance from the neck muscles.
• Kernig. It is impossible to straighten the bent leg of a newborn at a right angle if the baby is lying on his back.
• Lessage. The doctor lifts the baby by the armpits, holding the back of the head with his fingers. A sick newborn child involuntarily pulls his legs towards his stomach and keeps them bent for a long time.

Diagnostics

Meningitis in children and adults is treated by an infectious disease specialist or neurologist. Correct diagnosis in the initial stages of the disease is difficult. This is due to the fact that the first manifestations are similar to those of a common cold. To determine the disease, you need to apply the following diagnostic methods:

• Visual inspection. The doctor pays attention to the position of the sick child: he lies on his side, his knees are bent to his stomach, his head is thrown back, the muscles of the back of his head are tense. Multiple rashes are visible on the baby's skin. They are found throughout the body - from the feet to the eyeballs. The meningeal rash has a characteristic star pattern.
• Spinal tap. Doctors test the spinal cord fluid (CSF). With meningococcal infection, an increase in protein and a decrease in glucose levels are detected. Cerebrospinal fluid analysis may be performed every 5 days until the patient recovers.
• MRI. The method is prescribed by the doctor as additional research. MRI scanning allows you to determine possible complications meningitis, identify the cause of the disease.

Treatment

In case of meningitis, the newborn is placed in the infectious diseases department of the hospital. It is prohibited to treat a child at home, since the risk of severe complications and death is high. Therapy depends on the cause of the disease. The main principle of treating meningitis is eliminating the pathogen:

• If a meningococcal or other bacterial infection is detected, doctors prescribe a course of antibiotics.
• At viral disease Doctors prescribe treatment for the symptoms of the disease.
• For the fungal form, the basis of treatment is antimycotic agents.

Antibiotics

For meningitis, the basis of treatment is taking antibacterial drugs. Doctors prescribe broad-spectrum medications. They cause the death of harmful microorganisms. Antibiotics ( Amoxicillin, Cefotaxime, Gentamicin) is administered intravenously to newborns. The course of treatment with drugs is long - until the child recovers.

Anticonvulsants

Doctors prescribe this group of medications to eliminate seizures that occur in an infant due to damage to the central nervous system. Action anticonvulsants aimed at suppressing her work. Medicines prevent distribution in the brain and spinal cord nerve impulse. Anticonvulsant treatment consists of intravenous administration Seduxena, Sibazon.

Diuretics

To reduce brain swelling, doctors prescribe diuretics for children. They help eliminate headaches, nausea, and reduce intracranial pressure. To prevent dehydration of the body, diuretics are introduced into the child’s body along with big amount liquids. For the treatment of newborns, doctors prescribe Veroshpiron, Furosemide, Diacarb.

Consequences of meningitis in infants

If meningitis is not diagnosed in a timely manner or treated incorrectly, a child may develop a brain abscess. More than 80% of newborns with this diagnosis die. With meningoencephalitis, the survival rate is 15-20%. After treatment, rehabilitation is long - the child is registered. It is not always possible to completely cure a newborn, so a neurologist observes the baby for 2 years.

Possible consequences meningitis:

• cerebral edema;
• vascular thrombosis;
• cerebral hemorrhages;
• damage to the facial muscles;
• epileptic seizures;
• impaired mental function.

Meningitis: contagious or not?

Viral and bacterial form meningitis is transmitted from person to person. To prevent infection, you must adhere to preventive measures. Among them:

• Child vaccination. There are many antibacterial and antiviral vaccinations available to prevent infection.
• Minimizing contact with a sick person. If meningitis is suspected in the environment, the newborn should be immediately isolated.
• Careful hygiene measures. A newborn's belongings should only be for his use. They are not shared with other children.
• Maintaining immunity. Prevention is proper care looking after the baby, timely feeding, daily walks fresh air, quick disposal from colds.
• Know the symptoms of meningitis. If you know the first signs of the disease, for example, a rash on the body or neurological manifestations, many complications can be avoided. If symptoms appear, call immediately ambulance. A doctor can sometimes recognize meningitis even from a photo that shows a rash on the child’s skin.

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