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

## TL;DR

A non-invasive ultrasound device accurately detects meningitis in infants, potentially reducing the need for spinal taps.

## Contribution

This is the first non-invasive method for neonatal and infant meningitis screening using high-resolution ultrasound.

## Key findings

- The device achieved 94% accuracy in detecting elevated white blood cell counts in cerebrospinal fluid.
- It could reduce unnecessary lumbar punctures in low-suspicion cases and benefit low-income settings.
- The only false negative was due to a traumatic lumbar puncture with corrected WBC counts.

## Abstract

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.

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.

The algorithm was applied to 3782 images from 76 patients. It correctly classified 17/18 CSFs with \documentclass[12pt]{minimal}
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This non-invasive device could be an accurate tool for screening meningitis in neonates and young infants, modulating LP indications.

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).

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).