Neonatal bacterial meningitis continues to be an important cause of mortality and morbidity. Contributing factors to such mortality and morbidity include our incomplete knowledge on the pathogenesis of how meningitis-causing bacteria penetrate the blood brain barrier, emergence of antimicrobial resistance, and difficulty in early diagnosis of meningitis. An early empiric antibiotic treatment is critical for the management of neonates with bacterial meningitis, but early recognition of neonatal meningitis continues to be a challenge. Bacterial nucleic acid–based detection of pathogens and cerebrospinal fluid biomarkers will help in the development of early diagnosis of neonatal bacterial meningitis. Bacterial penetration of the blood brain barrier is essential for the development of meningitis, and the continued elucidation of microbial penetration of the blood brain barrier is likely to bring a new approach for prevention and therapy of neonatal bacterial meningitis.

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