Department of Neonatal Ward, Peking University First Hospital, Beijing, China.
Department of Pediatrics, Peking University Shenzhen Hospital, Shenzhen, China.
BMJ Paediatr Open. 2024 Jul 24;8(1):e002691. doi: 10.1136/bmjpo-2024-002691.
Bacterial meningitis (BM) poses a serious threat to infant health. We assessed cranial ultrasound (CUS) changes in infants with BM as possible predictors of the neurological sequelae of BM.
We retrospectively assigned 132 infants diagnosed with BM from 2007 to 2021. Neuroimaging characteristics and cerebral blood flow (CBF) profiles identified using CUS were analysed and compared between the groups during the acute and postacute phases of BM.
Overall, 102 infants with CUS and outcome data were recruited. 37/102 (36.3%) infants with neurological developmental impairments comprised the group with sequelae. Abnormal CUS findings increased the risk of sequelae during the postacute phase compared with the acute phase of BM. Prolonged white matter hyperechogenicity was an independent risk factor for sequelae. The CBF profiles of the group with sequelae showed that anterior cerebral artery resistance and pulsatility indices decreased during the acute phase, whereas the mean flow velocity of the middle cerebral artery significantly increased during the postacute phase. Changes in the CBF profiles did not significantly differ in the group without sequelae.
Serial CUS can facilitate the prognostic assessment of infants aged <90 days with BM. Prolonged white matter hyperechogenicity, brain volume loss and cerebral perfusion disorders contribute to the risk of sequelae.
细菌性脑膜炎（BM）对婴儿健康构成严重威胁。我们评估了 BM 婴儿的头颅超声（CUS）变化，以作为 BM 神经后遗症的可能预测指标。
我们回顾性地分配了 2007 年至 2021 年间诊断为 BM 的 132 名婴儿。分析并比较了 BM 急性期和亚急性期 CUS 确定的神经影像学特征和脑血流（CBF）特征。
共有 102 名婴儿接受了 CUS 检查并获得了预后数据。102 名婴儿中，37 名（36.3%）有神经发育损伤的婴儿为后遗症组。与 BM 急性期相比，亚急性期 CUS 异常发现增加了后遗症的风险。脑白质回声增强持续时间延长是后遗症的独立危险因素。后遗症组的 CBF 特征显示，大脑前动脉阻力和搏动指数在急性期下降，而大脑中动脉平均流速在亚急性期显著增加。无后遗症组的 CBF 特征变化无显著差异。
连续 CUS 有助于对<90 天龄的 BM 婴儿进行预后评估。脑白质回声增强持续时间延长、脑容量损失和脑灌注障碍是导致后遗症发生的危险因素。
