[Clinical value of cerebrospinal fluid metagenomic next-generation sequencing in the diagnosis of neonatal intracranial infection].

OBJECTIVES

To investigate the diagnostic performance of cerebrospinal fluid metagenomic next-generation sequencing (mNGS) for neonatal intracranial infections and its value in clinical decision-making.

METHODS

A retrospective observational study was conducted, enrolling neonates admitted to the Children's Hospital, Zhejiang University School of Medicine from 2020 to 2025 with suspected intracranial infection who underwent cerebrospinal fluid mNGS. The sensitivity of mNGS and its concordance with cerebrospinal fluid culture-quantitative polymerase chain reaction (qPCR) were calculated. Clinical impact was evaluated using predefined criteria, and samples were categorized accordingly into positive-impact and no-impact groups to explore independent factors influencing the positive impact of mNGS on clinical decision-making.

RESULTS

Among 61 neonates with suspected intracranial infection, 48 were confirmed. Pathogens were identified in 18 cases, of which 9 were detected exclusively by mNGS, accounting for 50% of etiological diagnoses. The sensitivity of mNGS was 31.3% (95%CI: 18.7%-46.3%), higher than that of cerebrospinal fluid culture-qPCR at 18.8% (95%CI: 8.9%-32.6%), though the difference was not statistically significant (P=0.15). The positive and negative concordance rates between mNGS and cerebrospinal fluid culture-qPCR were 66.7% (95%CI: 29.9%-92.5%) and 76.9% (95%CI: 60.7%-88.9%), respectively. mNGS positively influenced clinical decisions in 23 patients: 12 cases with positive results guided etiological diagnosis and treatment adjustment, while 11 cases with negative results led to antibiotic de-escalation or discontinuation. Multivariate analysis identified a positive mNGS result as an independent factor associated with positive clinical impact (OR=22.127, P<0.01).

CONCLUSIONS

Cerebrospinal fluid mNGS provides positive support in etiological diagnosis and clinical decision-making for neonatal intracranial infection.