Case Series Neonatal ventriculitis: a case series and review of literature Ramitha R Bhat 1 , Prerna Batra 2 , Ravi Sachan 3 and Gurbachan Singh 4 Abstract Ventriculitis after meningitis is a serious complication in the neonatal age group. The role of intraventricular antibiotics in treatment is controversial. We present five such cases which were refractory to conventional intravenous antibiotic therapy, had persistent features of ventriculitis and in whom raised intracranial pressure (ICP) necessitated insertion of an external ventricular drain (EVD). Three of the five infants required intraventricular antibiotics but also developed EVD-related complications. Early diagnosis of ventriculitis and treatment is necessary to avoid a fatal outcome. Intravenous antibiotics are the treatment of choice, but intraventricular therapy may be considered in refractory cases. As the incidence of EVD-associated ventriculitis is high, proper care of EVDs and their early removal is mandatory. Keywords Neonates, meningitis, ventriculitis, external ventricular drain Introduction Neonatal ventriculitis is a well-known complication of meningitis. Its incidence is in the range of 52%–94% after gram-negative meningitis. 1,2 It can be detected by ultrasonography. 3 Unrecognised ventriculitis or menin- gitis may cause infantile hydrocephalus, leading to sig- nificant morbidity or death. A majority of cases may be due to an infective aetiology. 4 Thus, it becomes import- ant to identify ventriculitis early and treat it effectively in neonates at risk. 4 There are no current recommen- dations for treatment of neonatal ventriculitis. 5 Treatment modalities used include intravenous anti- biotics alone, or intraventricular antibiotics via either an external ventricular drain (EVD) or reservoir. 6–8 The former carries the additional advantage of reducing raised intracranial pressure (ICP) and has been shown to be have improved cure rates, 5 though not being devoid of procedure-associated risks itself. Case series We report five cases of neonatal meningitis in five infants, four term and one preterm, who developed ventriculitis. Table 1 shows the comparative details of these cases. In case 1, the EVD was inserted for decom- pression of ventricles for a short duration of seven days, though no intraventricular antibiotics were given. Cases 2, 3 and 4 had a relatively long duration of EVD insertion as they were not responding to the ther- apy. Reinsertion of the EVD was done in case 2 (due to accidental removal) and case 3 (due to blockage of the EVD, infection and accidental removal). Reinsertion was done at a different site. In case 3, the EVD was removed, a ventriculoperitoneal (VP) shunt was per- formed, but the EVD had to be reinserted as a shunt infection had developed. Finally, a definitive VP shunt was inserted at six months of age. This infant was dis- charged one month later on nasograstic feeding with severe neurological impairment. Case 4 had a ruptured meningomyelocele at birth, which was the predisposing factor for infection. Case 5 did not show much 1 Senior Resident, Department of Pediatrics, University College of Medical Sciences and Guru Tegh Bahadur Hospital, Delhi, India 2 Professor, Department of Pediatrics, University College of Medical Sciences and Guru Tegh Bahadur Hospital, Delhi, India 3 Associate Professor, Department of Pediatrics, University College of Medical Sciences and Guru Tegh Bahadur Hospital, Delhi, India 4 Consultant, Department of Neurosurgery, University College of Medical Sciences and Guru Tegh Bahadur Hospital, Delhi, India Corresponding author: Prerna Batra, Professor, Department of Pediatrics, University College of Medical Sciences and Guru Tegh Bahadur Hospital, Delhi 110095, India. Email: drprernabatra@yahoo.com Tropical Doctor 0(0) 1–4 ! The Author(s) 2020 Article reuse guidelines: sagepub.com/journals-permissions DOI: 10.1177/0049475520927626 journals.sagepub.com/home/tdo