Abstract: Objective To investigate the clinical manifestations, treatment and prognosis of sepsis caused by Streptococcus agalactiae combined with purulent meningitis in neonates. Methods Clinical data of 12 neonates with purulent meningitis caused by Streptococcus agalactiae were analyzed retrospectively from January 2012 to May 2015. Results In 12 full term neonates (6 males and 6 females) , there were 4 early onset cases and 8 late onset cases; 7 cases of vaginal delivery and 5 cases of cesarean section. All of the mothers had no history of infections, and also no routine screening for group B streptococcus. The serum levels of procalcitonin were elevated in all neonates. Brain magnetic resonance imaging results indicated abnormal meningeal enhancement, subdural effusion in 5 cases and brain parenchyma involvement in 3 cases. One case was treated with penicillin only. One case was treated with meropenem first and then penicillin only with good efficacy. Most of the neonates need drug combination therapy. During 20 ~ 29 months of following-up, one case had language development delays, 2 cases had motor retardation, and the other 9 cases had a normal development. Conclusions The neonates with sepsis caused by Streptococcus agalactiae combined with purulent meningitis are critically ill. It is imperative to apply sensitive antibiotics in time or drug combination therapy when necessary. It is proposed to improve the prenatal screening.