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. 2025 Jul 23.
doi: 10.1038/s41390-025-04179-7. Online ahead of print.

Non-invasive meningitis screening in neonates and infants: multicentre international study

Sara Ajanovic  1   2   3   4 , Beatrice Jobst  5 , Javier Jiménez  5 , Rita Quesada  5 , Fabião Santos  5 , Francesc Carandell  5 , Manuela Lopez-Azorín  6 , Eva Valverde  7 , Marta Ybarra  7 , María Carmen Bravo  7 , Paula Petrone  8   9 , Hassan Sial  8   9 , David Muñoz  10 , Thais Agut  10 , Barbara Salas  10 , Nuria Carreras  11 , Ana Alarcón  11 , Martín Iriondo  11 , Carles Luaces  10 , Muhammad Sidat  12 , Mastalina Zandamela  13 , Paula Rodrigues  14 , Dulce Graça  14 , Sebastião Ngovene  14 , Justina Bramugy  13 , Anelsio Cossa  13 , Campos Mucasse  13 , William Chris Buck  15 , Sara Arias  16   8 , Chaymae El Abbass  17   18 , Houssain Tligi  17   18 , Amina Barkat  17   18 , Alberto Ibáñez  19 , Montserrat Parrilla  19 , Luis Elvira  19 , Cristina Calvo  20   21   22   23 , Adelina Pellicer  7   23 , Fernando Cabañas #  6   24 , Quique Bassat #  16   8   13   25   26   27 ; UNITED study group
Collaborators, Affiliations

Non-invasive meningitis screening in neonates and infants: multicentre international study

Sara Ajanovic et al. Pediatr Res. .

Abstract

Background and objectives: Meningitis diagnosis requires a lumbar puncture (LP) to obtain cerebrospinal fluid (CSF) for a laboratory-based analysis. In high-income settings, LPs are part of the systematic approach to screen for meningitis, and most yield negative results. In low- and middle-income settings, LPs are seldom performed, and suspected cases are often treated empirically. The aim of this study was to validate a non-invasive transfontanellar white blood cell (WBC) counter in CSF to screen for meningitis.

Methods: We conducted a prospective study across three Spanish hospitals, one Mozambican and one Moroccan hospital (2020-2023). We included patients under 24 months with suspected meningitis, an open fontanelle, and a LP performed within 24 h from recruitment. High-resolution-ultrasound (HRUS) images of the CSF were obtained using a customized probe. A deep-learning model was trained to classify CSF patterns based on LPs WBC counts, using a 30cells/mm3 threshold.

Results: The algorithm was applied to 3782 images from 76 patients. It correctly classified 17/18 CSFs with ≥ 30 WBC, and 55/58 controls (sensitivity 94.4%, specificity 94.8%). The only false negative was paired to a traumatic LP with 40 corrected WBC/mm3.

Conclusions: This non-invasive device could be an accurate tool for screening meningitis in neonates and young infants, modulating LP indications.

Impact: Our non-invasive, high-resolution ultrasound device achieved 94% accuracy in detecting elevated leukocyte counts in neonates and infants with suspected meningitis, compared to the gold standard (lumbar punctures and laboratory analysis). This first-in-class screening device introduces the first non-invasive method for neonatal and infant meningitis screening, potentially modulating lumbar puncture indications. This technology could substantially reduce lumbar punctures in low-suspicion cases and provides a viable alternative critically ill patients worldwide or in settings where lumbar punctures are unfeasible, especially in low-income countries).

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Conflict of interest statement

Competing interests: B.J., J.J., R.Q., F.S., and F.C. are employed by Kriba, the company developing the non-invasive device. S.A. received honoraries from Kriba for the scientific coordination of the multi-site study at ISGlobal. The Biomedical Data Science team at ISGlobal received training fees and consulting fees from Kriba to assist in the development of deep learning methods. Ethics approval and consent to participate: All participants in this study were enrolled with the informed consent of their caregivers, who provided written consent prior to participation in accordance with ethical standards and institutional guidelines

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