BACTERIAL MENINGITIS (BM) IN CHILDREN:
INTENSIVE CARE NEEDS AND OUTCOME
Singhi S.C, P.Singhi, R.Khetarpal
Department of Pediatrics, Post-graduate Institute of
Medical Education and Research, Chandigarh-160012, India
Rationale:
Data on childhood bacterial meningitis with reference to need for intensive
care and its impact on the outcome from developing countries is scarce.
Objective:
To examine in patients with bacterial meningitis proportion of patients who
require intensive care, reasons for their admission to Intensive Care Unit
(ICU) and the outcome.
Design:
Retrospective, hospital based cohort.
Location:
Pediatric service of a tertiary care multidisciplinary teaching
hospital.
Subject:
220 children hospitalised for BM between 1993 to 1996.
Results:
Of 220, 88 (40%) children were admitted to PICU and constituted 9.1% of all
PICU admission. 52 (59%) were in coma (Glasgow Coma Score<8), 39 (44%)
had clinically evident raised ICP, 28 (42%) respiratory distress or failure
and 21 (24.2%) had shock. Sixty-four (73%) children had seizures, 34 (53%)
of which were refractory status epilepticus (RSE). In 39 patients with
respiratory distress/ failure intubation was needed in 29 (74%) and
ventilatory support in 19 (49%). Nineteen (21.6%) children died. Of these
16 had GCS <8 (84%) at admission and 15 (79%) required support for at
least one of the above clinical conditions. Mortality was highest (60%)
when raised ICP, respiratory failure and shock all the three were present
together and was 33% and 20% when respiratory failure was present with
raised ICP and shock respectively.
Conclusion:
A significant number of cases of bacterial meningitis need PICU care.
Mortality is directly related to presence of raised ICP, shock and
respiratory failure at admission.