title: Recognising early meningitis: a missed opportunity to diagnose meningitis.
abstract: There are ∼250 cases of neonatal bacterial meningitis each year in the UK. Clinical evaluation of signs and symptoms of meningitis is challenging, particularly, during the neonatal period. Although uncommon, it is recognised that bacterial meningitis can be present in a child with an apparently normal cerebrospinal fluid (CSF) initially.We report the case of a newborn baby girl who was admitted with concerns regarding 2 dusky episodes. She underwent blood tests, a lumbar puncture and was started on intravenous antibiotics. With negative cultures, normal blood results and following a significant clinical improvement, antibiotics were discontinued after 48 hours and the baby was discharged home. She re-presented to the children's emergency department 7 hours later with a history of an apnoeic episode. A second CSF sample was suggestive of bacterial meningitis. We will discuss the published literature and the potential drawbacks of lumbar punctures and ways to diagnose meningitis early.
authors: Nottingham University Hospitals NHS Trust, Nottingham Children's Hospital, Nottingham, UK.
authors: Anusha
authors: A
authors: Ponnampalam
authors: Department of Paediatrics, Conquest Hospital, Saint Leonards on Sea, UK.
authors: Paula
authors: P
authors: de Sousa
authors: Department of Paediatrics, Royal Stoke University Hospital, Stoke-on-Trent, UK.
authors: Will
authors: W
authors: Carroll
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D057210:Delayed Diagnosis; D003951:Diagnostic Errors; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D016920:Meningitis, Bacterial / Q000134:cerebrospinal fluid / Q000175:diagnosis*; D013129:Spinal Puncture / Q000009:adverse effects
chemical_list: D000900:Anti-Bacterial Agents