Neonatal bacterial meningitis versus ventriculitis: a cohort-based overview of clinical characteristics, microbiology and imaging

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 post-haemorrhagic 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: CNS infections; Cranial ultrasound; Meningitis; Neonate; Ventriculitis.

Fig. 1

Ultrasound imaging from our cohort. (I) Top row shows images from ventriculitis patients. (II) Bottom row shows contrasting images from meningitis patients. IA: Slightly thickened ultrasound rich ventricle walls. IB: Coronal image of bilateral enlarged ventricles, with stranding in the right ventricle. IC: Coronal image showing hyperechoic lining of the gyri and sulci, hyperechoic peripheral CSF. ID: Hyperechoic appearance of white matter. IIA: Normal periventricular lining. IIB: Normal non-reflecting CSF. No hydrocephalus. IIC: Virtual normal lining. IID: Normal white matter surrounding the ventricles