INTENSIVE CARE NEEDS OF CHILDREN WITH BACTERIAL MENINGITIS AND OTHER CNS INFECTIONS

Singhi S

Advance Pediatric Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India

 

Bacterial and tuberculous meningitis (BM), and epidemic encephalitis remain important causes of morbidity and mortality in children inspite of availability of effective antibiotics and advanced intensive care technology. In developing countries prevalence of malnutrition, late presentation, use of inadequate antibiotic therapy prior to hospitalisation and predominance of pneumococcal, gram-negative and staphylococcal meningitis further compound the disease. Severely ill children with BM and other CNS infections may have coma, respiratory failure, shock, raised intracranial pressure, status epilepticus (SE) or hypoglycemia; all of which require intensive care and are strong predictors of neurologic sequelae or death. In our PICU 38% of 2350 admissions between 1994-99 were for CNS infections- predominantly bacterial meningitis (49%) and encephalitis (30%). In last 5 years, 40% of all bacterial meningitis patients required intensive care, for coma (56%), respiratory distress/failure (29%), intubation (41%) ventilation, management of shock 30.6%, status epilepticus 32% and raised ICP. Early management of respiratory and circulatory homeostasis, control of raised ICP, meticulous attention to diazepam infusion for SE can help in improving the outcome. We have witnessed a dramatic fall in mortality and sequelae in last five years in BM with above measures from 21.5% to 14.3%. Improved availability of Intensive care and early transfer of all patients suspected of CNS infections, particularly BM and encephalitis, to PICU may improve their outcome.

 

 
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