Neonatal pneumocephalus secondary to meningitis: a case report and literature review

Pneumocephalus secondary to meningitis is very rare in newborns. Early identification of this disease is challenging, and its prognosis is very poor. However, there is limited information about the management of neonatal pneumocephalus. Here, we report a case of pneumocephalus secondary to meningitis in an 8‑day‑old female newborn and conduct a literature review on reported cases of neonatal pneumocephalus to date. This neonate presented with fever, irritability, and poor feeding. Enterobacter cloacae grew in cerebrospinal fluid (CSF) and blood cultures, and pneumocephalus was detected by a computed tomography (CT) brain scan. The neonate died due to worsening pneumocephalus despite receiving active antibiotic treatment and supportive management. Among the 12 reported cases, the most common initial symptoms were poor feeding, lethargy, and abnormal body temperature, and CSF culture was positive in 11 cases, of which 5 were caused by Citrobacter koseri, 4 were caused by Enterobacter cloacae, 1 was caused by Proteus mirabilis, and 1 was caused by Acinetobacter baumannii. All patients had pneumocephalus according to CT brain scans. Treatment mainly included the administration of broad-spectrum antibiotics and supportive management. Twelve infants died, and the only surviving infant suffered from severe neurodevelopmental disorders. Increased awareness of neonatal pneumocephalus among neonatologists, vigilant monitoring and prompt changes to sensitive antibiotics guided by susceptibility testing may be beneficial for improving the clinical prognosis of the disease.