Iraqi children with acute bacterial meningitis... who may need ventilatory support?

ABSTRACT

Acute bacterial meningitis [ABM] is one of the most potentially serious infections occurring in infants and older children. Indications for PICU admission are shock, markedly elevated intracranial pressure [ICP], coma, and refractory seizures. [1] This cross sectional study enrolled children 2 months-12 years of age presented with [ABM] who were admitted to Children Welfare Teaching Hospital [CWTH] -Medical City- Baghdad, including those who needed Pediatric Intensive Care Units [PICUs] admission in CWTH Unit and Surgical Specialty Hospital [SSH] Unit in the period from the 1[st] of Feb 2004 to the 1[st] of Feb 2006. The diagnostic inclusion criteria of [ABM] were clinical symptoms and signs of meningitis plus a CSF neutrophilic pleocytosis with a CSF cells count of more than 5 cells/mm[3]. [1] Data included history, clinical examination, investigations, complications, PICU management, and outcome. Statistical analysis was done by using SPSS version 13.0 computer facility, Chi-square test and T test were used when needed and a P.value < 0.05 was considered significant. In the present study [ABM] in children 2 months -12 years constituted 7% of cases admitted to PICUs. The majority of cases [77.2%] were below 2 years of age. The mean age of children with [ABM] was 18.3 +/- 6.80 months. The PICU cases of [ABM] differed from the neurological ward cases in their more acute onset, higher body temperature, higher peripheral WBCC, lower CSF glucose, and higher CSF cell count, higher CSF protein, lower serum calcium and longer duration of stay and all these characteristics showed highly significant differences The case fatality rate of children with [ABM] is 13.3%. The study concluded the need for PICU admission in children with [ABM] with acute onset, higher body temperature, higher peripheral WBCC, lower CSF glucose, and higher CSF cell count, higher CSF protein, lower serum calcium, and recommended laboratory and PICU service expansion