meningitis%20-%20acute,%20bacterial%20(pediatric)
MENINGITIS - ACUTE, BACTERIAL (PEDIATRIC)
Acute meningitis is the bacterial infection of the subarachnoid space and cerebrospinal fluid that may cause local and systemic inflammatory response.
Common symptoms in newborns are lethargy, fever, seizures, irritability and bulging fontanelle. While in children the common symptoms are fever, nuchal rigidity (incidence increases with age) and altered consciousness.
Meningeal signs are stiff neck, Kernig's or Brudzinski's signs) are not reliably present in infants <6 months of age.
It may also observe the presence of persistent vomiting, changes in behavior or other psychological/neurologic signs.

Supportive Therapy

  • All patients suspected of having bacterial meningitis should be in respiratory isolation 24 hours after initiation of effective therapy
  • Patients who have not responded clinically after 48 hours of appropriate therapy should be monitored w/ repeated cerebrospinal fluid (CSF) analysis

Supervise Patient Closely

  • Monitor vital signs & neurologic status regularly
  • Perform complete neurologic exam & measure head circumference for children <18 months of age daily
  • Shock may develop in a patient with meningitis 
  • Patients with a depressed sensorium &/or seizures may need intubation for airway protection or assisted ventilation

Maintain Adequate Nutrition & Hydration

  • Record intake & output; the patient should receve fluids sufficient to maintain systolic blood pressure (SBP) at around 80 mmHg, urinary output of 500 mL/m2/day & adequate tissue perfusion
  • Depending on a patient’s altered mental state, tube feeding may be necessary
  • Assess the fluid status of the patient to determine whether IV fluid restriction is necessary

Other Laboratory Exams

  • Blood urea nitrogen (BUN), serum sodium, chloride, potassium & bicarbonate
  • Urine output & specific gravity
  • Complete blood count (CBC) & platelet count
    • In the presence of petechiae, purpura or abnormal bleeding, measure of coagulation function may also be assessed
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