What are the neurologic signs and symptoms of neonatal sepsis?

Updated: Jun 13, 2019
  • Author: Nathan S Gollehon, MD, FAAP; Chief Editor: Muhammad Aslam, MD  more...
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Meningitis is the common manifestation of central nervous system (CNS) infection. Acute and chronic histologic features are associated with specific organisms.

Meningitis due to early-onset neonatal sepsis usually occurs within 24-48 hours and is dominated by nonneurologic signs. Neurologic signs may include stupor and irritability. Overt signs of meningitis occur in only 30% of cases. Even culture-proven meningitis may not demonstrate white blood cell (WBC) changes in the cerebrospinal fluid (CSF).

Meningitis due to late-onset disease is more likely to demonstrate neurologic signs (80%-90%); however, many of these physical examination findings are subtle or inapparent. Neurologic signs may include the following:

  • Impairment of consciousness (ie, stupor with or without irritability)

  • Coma

  • Seizures

  • Bulging anterior fontanelle

  • Extensor rigidity

  • Focal cerebral signs

  • Cranial nerve signs

  • Nuchal rigidity

  • Central apnea or periodic breathing

Temperature instability is observed with neonatal sepsis and meningitis, either in response to pyrogens secreted by the bacterial organisms or from sympathetic nervous system instability. The neonate is most likely to be hypothermic. The infant may also have decreased tone, lethargy, and poor feeding. Signs of neurologic hyperactivity are more likely when late-onset meningitis occurs.

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