43 The utility of neuroimaging in neonates and infants with bacterial meningitis
Bibliographic record
Abstract
In order to reduce the chance of mortality or permanent neurologic sequelae, neonates and infants with suspected meningitis must be recognized and treated in a timely manner, including recognition of complications such as ventriculitis, hydrocephalus, stroke and intracranial abscess. Anecdotally, there is wide variation in the management of Canadian neonates and infants diagnosed with bacterial meningitis regarding the timing, modality, and indications for neuroimaging. Magnetic Resonance Imaging (MRI) imaging has become widely available in tertiary centres, but not in smaller hospitals. To review current literature regarding neuroimaging in neonates and infants with bacterial meningitis and summarize the utility of neuroimaging in this population in Canada. We conducted a PubMed search for English language case series describing term or preterm neonates and infants with confirmed bacterial meningitis and corresponding neuroimaging results, reported from countries where meningitis epidemiology would likely be similar to Canada. Out of 7 case series included in a final review, 4 focused on Group B Streptococcusmeningitis, 1 on Escherichia coliand 2 included various pathogens. Cranial ultrasound was frequently used in the acute setting (within 3 days of diagnosis). MRI was utilized for acute and/or follow-up imaging (3 days- 2 weeks after diagnosis). The most common indications for MRI imaging were failure of cerebrospinal fluid sterilization, seizures, or abnormal findings on neurologic examination. The most common ultrasound finding was increased echogenicity localized in various brain regions. 22/50 patients had normal ultrasound images, but 7 of these patients were found to have intracranial abnormalities on subsequent MRI. In GBS meningitis, multiple or diffuse ischemic infarcts were commonly seen on MRI. Abnormal imaging results led to a change in management in 47% of infants, regardless of causative pathogen. Changes in management included prolongation of antimicrobial therapy, addition of anticoagulant therapy, and neurosurgical intervention. Current literature suggests that cranial ultrasound may underestimate the presence of intracranial complications in neonates and infants with bacterial meningitis. Brain MRI may be a preferred modality in infants with bacterial meningitis who have persistently positive CSF cultures or abnormal neurological findings. As ischemic strokes appear to be more common in GBS meningitis, a lower threshold for MRI imaging, including vascular imaging, may be warranted to detect strokes early and treat to prevent new strokes from occurring.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.012 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.006 | 0.004 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.001 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".