Practices vary significantly as clinicians evaluate and manage febrile infants younger than 2 months of age. A retrospective review suggests that meningitis is extremely unlikely in well-appearing babies with initial laboratory results suggestive of urinary tract infection, and that cerebrospinal fluid analysis may not be necessary.
The effectiveness of the current vaccine schedule has led to a significant decline in the incidence of bacterial meningitis. Delays in recognition and antibiotic administration result in increased morbidity and mortality; therefore, clinicians must maintain a high degree of vigilance for the subtle findings of meningitis, particularly in infants. Current standards for selective imaging, diagnostic testing, and empiric antibiotics are discussed.
Plaintiffs’ 3-month-old daughter was taken to the hospital with a high fever and elevated pulse rate. The ED physician diagnosed an ear infection and discharged the infant with a prescription for antibiotics. Days later she was diagnosed with pneumococcal meningitis, hypoxic brain injury, and hydrocephalus. She lived for 20 more months. Plaintiffs sued the hospital and the ED physician, and they won a verdict of joint and several liability for $1.7 million.