Late-onset meningitis in sick, very-low-birth-weight infants. Clinical and sonographic observations
J. M. Perlman, N. Rollins and P. J. Sanchez
Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas 75235-9063.
OBJECTIVES--To determine the clinical and sonographic features of
late-onset meningitis (after 7 days of life) in sick, very-low-birth-weight
infants. DESIGN--Retrospective study of a patient series. SETTING--Neonatal
intensive care nursery at Parkland Memorial Hospital in Dallas, Tex.
PARTICIPANTS--Ten preterm infants with birth weights of more than 1750 g
who developed late-onset meningitis during a 42-month study period.
INTERVENTIONS--None. RESULTS--Ten preterm infants developed meningitis at a
mean (+/- SD) postnatal age of 20 +/- 14 days. Eight of the infants
survived. Initial clinical signs were nonspecific, eg, apnea and
bradycardia (eight infants), abdominal distention (five infants),
hyponatremia (serum sodium level, < 130 mmol/L), and a decrease in urine
output with an increase in weight (three infants). Specific neurologic
signs occurred in three infants (seizures [n = 2] and third-nerve palsy [n
= 1]). Sonographic abnormalities noted in seven (70%) of the 10 infants
included progressive ventriculomegaly (n = 6), thalamic echodensities (n =
3), ventriculitis (n = 4), and cystic leukomalacia (n = 1). The progressive
ventriculomegaly developed from 1 to 2 weeks after diagnosis; permanent
shunting was required in all six infants. The thalamic echodensities were
linear or punctate and developed from 1 to 2 weeks after diagnosis in two
infants. CONCLUSIONS--The data indicate the need for a high index of
suspicion of meningitis in very-low-birth-weight infants suspected of
having sepsis because of the nonspecific clinical presentation of
meningitis. Because both progressive ventriculomegaly and thalamic
echodensities are late and frequent findings, serial sonograms are
essential for careful monitoring of sequelae of disease.
