Bacterial Meningitis (BM) is associated with high case fatality rates (20-50%), causing around 60,000 annual newborn deaths, further 180.000 annual deaths in older children (1-59 months), and significant sequelae among survivors.
In developed countries, BM detection is challenging due to the unspecific signs associated to the infection, such as fever with no known source, and particularly in infants and newborns with very little symptomatology. Therefore, history and physical examination alone are often insufficient to confirm or exclude the diagnosis. Lumbar puncture (LP) to draw a sample of cerebrospinal fluid (CSF) is an essential investigation, but difficult to perform and potentially hazardous for the sick child. In the current practice, if CSF WBC count – directly counted in the obtained CSF after conducting a LP and available within an hour – is increased, medication targeting the most frequent pathogens is immediately administered while waiting for bacteriologic results available after 24h-72h.
In this context, where the incidence of meningitis is relatively low (0.2-1/1,000 pyar) and the referral rate to hospitals for any febrile infant is high, up to 95% of lumbar punctures in infants (<1 year) are negative for meningitis. For instance, in leading University Hospitals in Spain attending a large volume of patients no less than 200 LPs are performed annually in infants not to miss a meningitis case. However, less than 5% meningitis cases are diagnosed within the same period. When extrapolating to EU figures, 271 infants unnecessarily receive a LP in the EU every day (100.000 LPs/year) when only 14 of them really need it. In the USA, 80.000 LPs are performed in infants every year and only (and fortunately) 400 are eventually diagnosed with meningitis.
Neosonics can be used not to miss a case of meningitis and provide a better management and care of neonatal and infant at risk or confirmed meningitis. Clearly, patients with criteria for having an LP conducted may be initially screened using the Neosonics, a quicker, safer and painless procedure in comparison to the LP. A positive suspicion of BM, as provided by the Neosonics, will trigger a confirmatory LP, or the initiation of evidence-based empiric antibiotherapy in places where LPs or laboratory assessments are not available. A negative screening will, with a high degree of certainty, disregard BM as the likely diagnosis. Whith this innovative screening device, parents will have their child well managed in an effective, safe and non-traumatic manner, and hospitals will deliver a higher standard of care and a more cost-effective management of the patient with meningeal signs, the patient with confirmed meningitis, or the patient receiving intensive care at risk of meningitis due to prematurity or brain surgery.
Neosonics can also be extremely valuable to assess patient response of meningitis patients through a non-invasive tracking of CSF cellularity. At this moment, there is little information about the progress of the infection in relation to the causing organism and the Neosonics can help characterize such behaviour or pattern. Such information can be used to better understand the disease and make a more efficient use of medication and hospitalization resources while improving patient care since early discharges may be considered if progression is positive according to clinical information and the non-invasive count of CSF cellularity. Finally, the Neosonics can be used in patients suspected for meningitis that have some coagulopathy, low level of plaques, increased CSF pressure, etc. but where the LP is not indicated.
