Neonatal bacterial meningitis versus ventriculitis: a cohort-based overview of clinical characteristics, microbiology an
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ORIGINAL ARTICLE
Neonatal bacterial meningitis versus ventriculitis: a cohort-based overview of clinical characteristics, microbiology and imaging Thomas Peros 1
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& Joost van Schuppen & Anneloes Bohte & Caspar Hodiamont & Eleonora Aronica & Timo de Haan
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Received: 11 February 2020 / Revised: 17 June 2020 / Accepted: 22 June 2020 # The Author(s) 2020
Abstract Central nervous system (CNS) infections are potentially life threatening in neonates and can lead to the ill-defined diagnosis of ventriculitis. With this study we aimed to explore and describe ventriculitis regarding clinical, microbiological and ultrasonographic characteristics. We performed a retrospective cohort study including all neonates with a culture-proven CNS infection admitted to our tertiary NICU over a 12-year period (2004–2016). For each case clinical data was gathered, and three timed cranial ultrasounds were anonymized and retrospectively reviewed and assessed for signs of ventriculitis. Forty-five patients were included with 9 (20%) diagnosed with ventriculitis. Mortality in both ventriculitis and non-ventriculitis cases was one-third. Patients with pre-existing conditions as posthaemorrhagic hydrocephalus are at risk of developing ventriculitis. Most common pathogens were gram negative bacteria (68.9%). Ultrasonographic signs of ventriculitis developed over time, and interrater agreement was substantial. Conclusion: Neonatal ventriculitis is a serious entity in the continuum of meningitis. Early and correct diagnoses of ventriculitis are both important because of possible persisting or newly developing hydrocephalus or seizures. Sequential imaging should be performed. What is Known: • CNS infections in neonates lead to high mortality and morbidity. • Ventriculitis is a severe complication of meningitis. What is New: • High morbidity; the majority of ventriculitis patients have pre-existing PHVD and develop seizures and hydrocephalus. • Interrater agreement is good; bedside CUS is a useful tool for reaching a sustainable diagnosis of ventriculitis.
Keywords Ventriculitis . CNS infections . Meningitis . Neonate . Cranial ultrasound
Communicated by Daniele De Luca Electronic supplementary material The online version of this article (https://doi.org/10.1007/s00431-020-03723-3) contains supplementary material, which is available to authorized users. * Thomas Peros [email protected] Joost van Schuppen [email protected] Anneloes Bohte [email protected]
Caspar Hodiamont [email protected] Eleonora Aronica [email protected] Timo de Haan [email protected] Extended author information available on the last page of the article
Eur J Pediatr
Abbreviations BW Birth weight CUS Cranial ultrasound scan CVL Central venous line GA Gestational age GBS Group B streptococci IVH Intraventricular haemorrhage NEC Necrotizing enterocolitis PDA Patent ductus arteriosus PHVD Post haemorrhagic ventricular dilatation RI Intracranial resistive index TPN Total parenteral nutrition
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