No matter what the age of the person, meningitis is a dreaded diagnosis.
Meningitis is defined as the inflammation of the meninges (membranes) that surround the brain and spinal cord. Bacteria, viruses, fungi, parasites, and amoeba can all cause meningitis.
Meningitis is more common in the neonatal period, meaning babies less than 44 days old, than in any other age group. It is so common, in fact, that this condition is referred to as neonatal meningitis.
Diagnosis of meningitis in babies is often more challenging for healthcare providers than diagnosing the condition in older patients. In adults, the classic symptoms include a terrible headache, fever, and stiff neck. In potential neonatal meningitis cases, though, patients cannot report what they are feeling, so doctors look for signs like fever, irritability, and shortness of breath (dyspnea).
When doctors, nurse practitioners, or physician assistants suspect neonatal meningitis, the standard of care requires them to order a lumbar puncture (spinal tap). To perform the lumbar puncture, a doctor inserts a needle into the spinal canal to obtain a sample of cerebrospinal fluid (CSF) for diagnostic testing in a lab.
I am currently investigating a case involving a newborn who developed a meningitis infection at a Memorial Hermann hospital. This baby’s meningitis was caused by a gram-negative bacterium called Enterobacter.
As a Houston, Texas medical malpractice attorney, any time Painter Law Firm investigates a potential case, we hire a medical expert to study the medical records and determine if negligent healthcare was involved.
In the neonatal meningitis case that I am currently working on, we hired a renowned pediatric infectious diseases expert to study the medical records. I recently spoke with this expert and want to share what he explained concerning the three different types of negligence that he looks for in any neonatal meningitis case.
One potential cause of neonatal meningitis is a system-level problem with the hospital. This refers to a problem with hand hygiene, management of central lines, and how often nurses draw blood from babies for laboratory studies. Each of these factors make babies more vulnerable to infection.
Products used to decontaminate the skin of healthcare providers first kill gram-negative bacteria, like Enterobacter, and then later gram-positive bacteria, like Staphylococcus. Thus, sloppy disinfection practices at a hospital typically cause outbreaks of gram-negative meningitis infections.
To conclude that there is a system-level problem with the hospital, which is causing neonatal meningitis, pediatric infectious diseases experts look for at least three meningitis cases within one month. This can be difficult to prove because neither the federal government nor the Texas state government requires hospitals to report their meningitis infection rates.
Infectious diseases management
Another potential cause of neonatal meningitis is improper antibiotic management after the condition has been diagnosed. To assess this point, the medical expert looks at laboratory results from the lumbar puncture and blood work, and then compare them to the antibiotics selected by the physicians. Their focus is to determine whether the antibiotics would be effective against the bacteria causing the infection.
According to the pediatric infectious diseases medical expert that we retained, the standard of care requires sequential blood cultures to monitor how the antibiotic therapy is performing. It is pretty common for blood cultures to remain positive for 24-48 hours after antibiotics are started. After that, the goal is to see a negative blood culture.
If the medical team does not promptly start therapy with the correct antibiotics and does not follow through with appropriate diagnostic laboratory testing, it would be negligent healthcare. With meningitis, the sooner it is diagnosed and correctly treated, the more likely there will be a positive outcome for the patient.
The baby’s condition 48 hours before diagnosis and treatment
If there is not a system problem with the hospital and doctors implemented the correct antibiotic therapy, then the last area of potential negligence involves the baby’s condition in the 48 hours before the diagnosis and treatment of neonatal meningitis.
For this point, lab work provides a wealth of forensic information.
Once a cerebrospinal fluid (CSF) sample is obtained from a lumbar puncture, it is sent to a laboratory for analysis. One of the things that lab techs look for is the number of white blood cells per cubic milliliter of CSF. White blood cells (WBCs) are the bodies infection-fighting infantry.
When a meningitis infection gets into the CSF, it provides a perfect environment for multiplication because there is no immune resistance there. As the infection-causing bacteria replicate, they produce toxins and inflammatory changes that attracts white blood cells. Getting white blood cells to the CSF takes time, and that they must migrate through body tissues to arrive at their destination.
A medical expert can look at lab work from the hospitalization to determine a time window of when the baby developed meningitis. In the Enterobacter neonatal meningitis case that I am currently investigating, our expert looked closely at the results of the lumbar puncture.
The expert explained that, for neonatal meningitis caused by Enterobacter, the WBC ranges are as follows:
No meningitis: 0 to minimal WBCs per cubic mL of CSF
Early meningitis: 20-50 WBCs per cubic mL of CSF
Established meningitis: Hundreds of WBCs per cubic mL of CSF
Severe meningitis: Thousands of WBCs per cubic mL of CSF
In our case, the lumbar puncture lab work revealed that there were 1500 WBCs per cubic mL of CSF. The expert explained that this finding means that the baby developed meningitis around 48 hours prior to diagnosis and the beginning of antibiotic treatment.
This information allowed us to focus our investigation in the case on the baby’s signs and symptoms during the 48-hour period before the meningitis diagnosis was made. The type of things we look for include documentation of fever, irritability, shortness of breath, and signs of any infection.
Hiring an experienced medical malpractice attorney matters
Under the unique requirements of Texas law, medical malpractice cases must be carefully developed and managed. One of the major hurdles for patients pursuing a medical negligence claim is obtaining the support of a medical expert very early in the case, without the benefit of any written discovery or depositions. For reasons like this, it is important to hire an experienced medical malpractice lawyer.
If you or someone you love has been seriously injured because of misdiagnosis or poor treatment of meningitis, our experienced medical negligence attorneys can help. Click here to send us a confidential email via our “Contact Us” form or call us at 281-580-8800.
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Robert Painter is a medical malpractice attorney at Painter Law Firm PLLC, in Houston, Texas. He is a former hospital administrator who represents patients and family members in medical negligence and wrongful death lawsuits against hospitals, physicians, surgeons, anesthesiologists, and other healthcare providers. In 2017, H Texas magazine named him one of Houston’s top lawyers. Also in 2017, the Better Business Bureau recognized Painter Law Firm PLLC with its Award of Distinction.