We thank Dr Rashmi Ranjan Das for his interest in our recent article in TMIH (Furyk et al. 2011) and welcome the comments. We appreciate that the area of neonatal meningitis is broad and that definitions and opinions vary both between colleagues and continents.

In preparing this review, we aimed to encompass as many relevant papers as possible. Different investigators have used varying definitions of the neonatal period. In order not to overlook any important data, we included studies that range beyond what may classically be considered the neonatal period. We hope we have been clear in describing the age bracket that each study refers to so that readers can interpret these results with confidence. We believe meaningful conclusions may thus still be drawn with less risk of discounting potentially important studies.

Dr Das is correct in his assertion that presentation of neonatal meningitis is diverse, and we tried to include common presentations. We appreciate other symptoms are possible and underline the necessity for a high diagnostic suspicion in this age group. As mentioned above, the interesting study by Mathur et al. (2010) examines these factors prospectively in detail with a view to the severity of neonatal inflammatory response.

With regards to CSF sampling, we consider this to be extremely important not only to identify the organism and thus its sensitivities, but also to help determine duration of antibiotics required. Length of treatment is another factor that is highly variable between units and countries. Unfortunately, space did not permit us to discuss it in our review. Furthermore, we appreciate that CSF WBC and RBC counts change with the maturation of the blood brain barrier and CSF protein and glucose levels (Polin & Harris 2001, Garges et al. 2006) and the numbers of WBCs and glucose level fall with increasing time between CSF sampling and processing (Rajesh et al. 2010). For these reasons, we aimed to stress the importance of a positive culture as the gold-standard for diagnosis within our paper.

All systematic reviews must have a pre-defined remit, and we hope we have been clear with ours. A review of studies looking at only low-birth-weight neonates or sub-dividing early and late onset aetiological organisms would be extremely interesting, and we would be keen to read such an analysis.


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  2. References
  • Furyk J, Swann O & Molyneux E. (2011) Systematic Review: neonatal meningitis in the developing world. Tropical Medicine and International Health 16, 672679.
  • Garges HP, Moody A, Cotten M et al. (2006) Neonatal meningitis: what is the correlation among cerebrospinal fluid cultures, blood cultures, and cerebrospinal fluid parameters? Pediatrics 117, 10941100.
  • Mathur N, Marmu K & Kumar S. (2010) Systemic inflamatory response syndrome in home delivered neonates: a prospective observational study. Indian Journal of Pediatrics 77, 11091113.
  • Polin R & Harris M. (2001) Neonatal bacterial meningitis. Seminars in Neonatology 6, 157172.
  • Rajesh N, Dutta S, Prasad R & Narang A. (2010) Effect of delay in analysis on neonatal cerebrospinal fluid parameters. Archives of Disease in Childhood. Fetal and Neonatal Edition 95, F25F29.