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Subdural effusion and its relationship with neurologic sequelae of bacterial meningitis in infancy: a prospective
J D Snedeker1, S L Kaplan, P R Dodge
1Edward Mallinckrodt Department of Pediatrics, Washington University School of Medicine, St Louis, Missouri.
Insights
Subdural effusion is common in infants with bacterial meningitis, but it does not lead to long-term issues. Most infants with meningitis and effusion who are improving do not require invasive therapy.
Area of Science:
- Pediatrics
- Infectious Diseases
- Neurology
Background:
- Bacterial meningitis is a serious infection in infants.
- Subdural effusions can be a complication of bacterial meningitis.
- The long-term impact of subdural effusions in infants with meningitis requires further investigation.
Purpose of the Study:
- To determine the incidence of subdural effusion in infants with bacterial meningitis.
- To identify risk factors associated with the development of subdural effusion.
- To evaluate the long-term neurologic outcomes in infants with meningitis and subdural effusion.
Main Methods:
- Systematic screening using transillumination in 113 infants (1-18 months) with acute bacterial meningitis.
- Serial assessments for subdural effusion development during treatment.
- Long-term follow-up (median 5.5 years) to assess neurologic deficits, seizures, hearing loss, and developmental delay.
Main Results:
- Subdural effusion developed in 39% of infants during treatment.
- Risk factors included young age, rapid onset, low white blood cell count, and high CSF protein/bacterial antigen.
- Patients with effusion had more initial and short-term neurologic abnormalities and seizures, but no increased long-term adverse outcomes.
Conclusions:
- Subdural effusion is a frequent complication of bacterial meningitis in infants.
- Specific invasive therapy is not indicated for infants with meningitis and subdural effusion who are otherwise improving.
- Subdural effusion does not appear to adversely affect long-term neurologic outcomes.
Abstract:
One hundred thirteen infants, aged 1 to 18 months, were screened systematically and serially using transillumination for the presence of subdural effusion during acute bacterial meningitis due to Haemophilus influenzae type b, Streptococcus pneumoniae, or Neisseria meningitidis. Effusion developed in 44 (39%) of the patients during the course of treatment. Young age, rapid onset of illness, low peripheral white blood cell count, and high cerebrospinal fluid levels of protein and bacterial antigen were associated with a higher likelihood of developing effusion. Although patients with effusion were more likely to have neurologic abnormalities both at the time of admission and at completion of therapy, and were more likely to have seizures during the course of treatment, there was no greater incidence of seizures, hearing loss, neurologic deficits, or developmental delay on longterm follow-up (median follow-up interval 5.5 years) in patients with effusion. Specific invasive therapy is not indicated in infants with meningitis and subdural effusion who are otherwise improving.