[Neonatal meningitis, ventriculitis, intraventricular therapy or not?]

Neonatal meningitis still remains a disease with high mortality in spite of systemic treatment with in vitro active antibiotics. Of 42 consecutive cases, the fatality rate was 36%; Among the 27 survivors, there were 7 patients with extensive neurological and psychological impairment. The pathogenesis of the ventriculitis is discussed on the basis of the histomorphological structure of the ependyma, the subependymal tissue and the glycogen-rich choroid plexus within the first few weeks after birth. It seems, that this structure facilitates local bacterial growth and acts as a bacterial reservoir, relatively resistant to antimicrobial agents. The goal of therapy in neonatal meningitis should be directed to achieve a high concentration of the antimicrobial agent in the fore mentioned tissues. The intraventricular route should be considered.