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.