Bacterial infections in newborns. Meningitis in newborns.

1. Big picture

Neonatal bacterial infection is an emergency because newborns do not localize infection well. A baby with sepsis or meningitis may not have fever, neck stiffness, or obvious meningeal signs. Instead, the examiner expects you to recognize the pattern:

Poor feeding + temperature instability + respiratory distress/apnea + lethargy/irritability = neonatal sepsis until proven otherwise.

Neonatal meningitis is usually a complication of bacteremia. In newborns, meningitis can be clinically silent, so lumbar puncture must be considered whenever there is suspected sepsis, positive blood culture, seizures, abnormal neurological signs, or persistent illness.