Frequency and prediction of abnormal findings on neuroimaging of infants with bulging anterior fontanelles.
OBJECTIVE
This study sought to determine the frequency of clinically significant abnormal findings on neuroimaging using neurosonography (NS) in infants with bulging anterior fontanelles (BAFs) and to identify infants at high or low risk for clinically significant abnormal findings on neuroimaging.


METHODS
NS was performed in 45 consecutive infants with BAFs brought to the emergency department of a tertiary care hospital. NS reports were categorized as normal, clinically insignificant abnormal, or clinically significant abnormal. For each patient, demographic data, laboratory test results, and clinical diagnosis and outcome were obtained for analysis.


RESULTS
Eighteen febrile and 27 nonfebrile infants with BAFs were evaluated. Clinically significant abnormal findings on NS were noted in 16 of 45 patients (36%), five of whom were febrile and 11 of whom were nonfebrile. Brain edema resulting from infection was the most common finding on NS. Univariate analysis indicated that age younger than two months in febrile patients and abnormal findings on neurologic examination in nonfebrile patients were significant clinical predictors for clinically significant abnormal findings on NS in infants with BAFs. Patients presenting with either of these clinical predictors were identified as high risk for abnormal findings on NS. Of the high-risk patients, 15 of 17 patients (88%) had clinically significant abnormal findings on NS, compared with one of 28 patients (4%) in the low-risk group.


CONCLUSIONS
This study shows a 36% prevalence of clinically significant abnormal findings on NS in infants with BAFs. Emergent neuroimaging should be considered for infants who meet high-risk criteria: 1) febrile children younger than two months or 2) nonfebrile children with abnormal findings on neurologic examination.
Tu
Yi-Fang
YF
Department of Emergency Medicine, National Cheng Kung University Hospital,Tainan, Taiwan. doulp@ms42.hinet.net
Chuang
Hung-Yi
HY
Huang
Chao-Ching
CC
Chuang
Chia-Chang
CC
Wang
Shih-Min
SM
Tsai
Ming-Che
MC
Chi
Chin-Hsien
CH
Chuang
Ming-Che
MC
D001929:Brain Edema / Q000150:complications / Q000000981:diagnostic imaging*; D002494:Central Nervous System Infections / Q000150:complications / Q000000981:diagnostic imaging*; D003393:Cranial Sutures / Q000000981:diagnostic imaging*; D005260:Female; D005334:Fever / Q000209:etiology; D006801:Humans; D006849:Hydrocephalus / Q000150:complications / Q000000981:diagnostic imaging; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008581:Meningitis / Q000150:complications / Q000000981:diagnostic imaging; D017063:Outcome Assessment, Health Care; D011237:Predictive Value of Tests; D014463:Ultrasonography