Viral and bacterial infections of the central nervous system (CNS) are not a common problem in the neonatal intensive care unit, but they are an important cause of mortality and morbidity. In a recent study of babies with bacterial infection of the CNS the mortality was reported to be as high as 43% (1). The mortality was higher for preterm compared to term infants (50% compared to 30%) [1,2]. Thorough evaluation of affected babies is essential in order to establish the correct diagnosis, institute prompt and effective treatment, and evaluate the prognosis.
Infections of the CNS include bacterial, fungal meningitis and viral meningitis, together with meningoencephalitis and cerebral abscess. Perinatal CNS infection can occur antenatally or postnatally, and is often part of the TORCH (Toxoplasmosis, Other agents, Rubella, Cytomegalovirus, Herpes simplex) spectrum. Infections during the first trimesters can also lead to disruption of normal brain development .
In this chapter we describe the approach to the infant with infections of the CNS, including specific advice on the interpretation of CNS investigations.
Clinical presentation of neonatal sepsis involving the central nervous system
Family history, past obstetric history
As ever, we cannot overstress the importance of starting with a good history. Several viral infections can occur when there is reactivation of a dormant maternal viral infection, and management of the mother whose previous child was affected by group B streptococcal infection is well described elsewhere.