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Chapter 25. Central Nervous System Infections

A 13-day-old former 35-week gestational age baby presents to the emergency room with a temperature of 102°F. The mother reports the baby has been feeding less, is constipated, and is very irritable. Which of the following is a common symptom of meningitis in a neonate? Select all that apply.

a. Temperature of 102°F

b. Decreased feeding

c. Constipation

d. Irritable appearance

Answer a is correct. Fever is a common symptom of meningitis in a neonate.

Answer b is correct. Decreased feeding is a common symptom of meningitis in a neonate.

Answer d is correct. Irritability is a common symptom of meningitis in a neonate.

Answer c is incorrect. Constipation is not a common symptom of meningitis in a neonate.

A 13-day-old former 35-week gestational age baby presents to the emergency room with a temperature of 102°F. The mother reports the baby has been feeding less, is constipated, and is very irritable. The emergency physician is unable to obtain cerebrospinal fluid (CSF) after multiple attempts. Based on clinical findings, the team believes that the 13-day-old former 35-week gestational age baby may have meningitis. What is the best empiric therapy to begin in this baby before sending her to a pediatric hospital?

a. Ampicillin and gentamicin

b. Ceftriaxone and gentamicin

c. Vancomycin and cefotaxime

d. Ampicillin and ceftriaxone

Answer a is correct. Ampicillin provides appropriate empiric coverage for Listeria monocytogenes and Streptococcus agalactiae (may cover some aerobic gram-negative bacilli as well). Gentamicin provides appropriate empiric coverage against aerobic gram-negative bacilli (and some synergy with ampicillin against gram-positives, such as L. monocytogenes). Ampicillin and cefotaxime would also be an appropriate regimen.

Answer b is incorrect. While gentamicin is appropriate, this regimen is missing first-line empiric coverage for L. monocytogenes (ie, ampicillin). Also, ceftriaxone is not a first-line agent for bacterial meningitis in neonates (≤28 days) due to risk of adverse events, for example, biliary sludging, kernicterus, and potentially life-threatening precipitation with calcium-containing products.

Answer c is incorrect. While cefotaxime is appropriate, this regimen is missing empiric coverage for L. monocytogenes (ie, ampicillin). Also, vancomycin is broader empiric gram-positive coverage than is generally needed for neonates.

Answer d is incorrect. While ampicillin is appropriate, cefotaxime is the preferred third-generation cephalosporin in neonates. Ceftriaxone is not a first-line agent for bacterial meningitis in neonates (≤28 days) due to risk of adverse events, for example, ...

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