Clinical Characteristics and Risk Factors for Poor Outcome in Infants Less Than 90 Days of Age With Bacterial Meningitis in the United Kingdom and Ireland

Okike, Ifeanyichukwu; Ladhani, Shamez; Johnson, Alan P.; Henderson, Katherine L.; Blackburn, Ruth; Müller‐Pebody, Berit; Cafferkey, Mary T.; Anthony, Mark; Ninis, Nelly; Heath, Paul T

doi:10.1097/inf.0000000000001917

Cited by 28 publications

(46 citation statements)

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“… 1 During 2010–2011, we conducted national, prospective, population-based surveillance of bacterial meningitis in infants younger than 3 months of age in the UK and Ireland and found that 26% of 329 infants had poor outcomes at discharge. 2 Among survivors of neonatal meningitis in the 1980s, 50% had neurological sequelae at 5 years of age, 3 and similar rates (40%) have been reported in survivors of neonatal bacterial meningitis in the 1990s 4 .…”

Section: Introductionmentioning

confidence: 63%

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Assessment of healthcare delivery in the early management of bacterial meningitis in UK young infants: an observational study

et al. 2017

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ObjectiveTo define early presenting features of bacterial meningitis in young infants in England and to review the adequacy of individual case management as compared with relevant national guidelines and an expert panel review.DesignRetrospective medical case note review and parental recall using standardised questionnaires.SettingEngland and Wales.ParticipantsInfants aged <90 days with bacterial meningitis diagnosed between July 2010 and July 2013.ResultsOf the 97 cases recruited across England and Wales, 66 (68%) were admitted from home and 31 (32%) were in hospital prior to disease onset. Almost all symptoms reported by parents appeared at the onset of the illness, with very few new symptoms appearing subsequently. Overall, 20/66 (30%) infants were assessed to have received inappropriate prehospital management. The median time from onset of first symptoms to first help was 5 hours (IQR: 2–12) and from triage to receipt of first antibiotic dose was 2.0 hours (IQR: 1.0–3.3), significantly shorter in infants with fever or seizures at presentation compared with those without (1.7 (IQR: 1.0–3.0) vs 4.2 (IQR: 1.8–6.3) hours, p=0.02). Overall, 26 (39%) infants had a poor outcome in terms of death or neurological complication; seizures at presentation was the only significant independent risk factor (OR, 7.9; 95% CI 2.3 to 207.0). For cases in hospital already, the median time from onset to first dose of antibiotics was 2.6 (IQR: 1.3–9.8) hours, and 12/31 (39%) of infants had serious neurological sequelae at hospital discharge. Hearing test was not performed in 23% and when performed delayed by ≥4 weeks in 41%.ConclusionsIn young infants, the non-specific features associated with bacterial meningitis appear to show no progression from onset to admission, whereas there were small but significant differences in the proportion of infants with more specific symptoms at hospital admission compared with at the onset of the illness, highlighting the difficulties in early recognition by parents and healthcare professionals alike. A substantial proportion of infants received inappropriate prehospital and posthospital management. We propose a targeted campaign for education and harmonisation of practice with evidence-based management algorithms.

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Section: Introductionmentioning

confidence: 63%

“…In our national surveillance, for example, half the infants with bacterial meningitis did not have fever at presentation and only 5% had the classic triad of fever, bulging fontanelle and seizures. 2 …”

Section: Introductionmentioning

confidence: 99%

Assessment of healthcare delivery in the early management of bacterial meningitis in UK young infants: an observational study

et al. 2017

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“…We describe the first phase of development of the SIGNS-for-Kids (SIGNES Enfant) tool—a five-item public health tool to; (1) help parents and other lay-caregivers identify acute severe illness in children, and (2) support the articulation and efficient communication of parental and lay concerns to healthcare professionals and (3) to facilitate timely escalation of care. The selected signs, criteria and cues align with other tools listing symptoms described in case series of severe infection in infants,9 36 the criteria of the Advanced Paediatric Life Support assessment triangle,37 the lived experience of a diverse group of paediatric clinicians, the perspectives of parental representatives and selected cases of delayed recognition of severe illness resulting in medical-legal action. The panel’s selection of severe acute illness as a threshold was a balancing principle to prevent adversely increasing attendance at emergency departments for children who did not require urgent medical attention as this could have counterproductive service delivery effects at the system level.…”

Section: Discussionmentioning

confidence: 98%

“…Further reductions in mortality may be achieved by understanding and shortening the duration from symptom onset to definitive treatment. In a series of infants with bacterial meningitis in the UK, 24% presented to the hospital >24 hours after symptom development8; this seemingly delayed presentation was associated with both increased mortality and neurologic morbidity 9. Other severe illnesses including stroke,10 11 malignancy12–14 and kernicterus15 16 can result in permanent injury and are also time-sensitive in terms of their need for definitive treatment.…”

Section: Introductionmentioning

confidence: 99%

Severe illness getting noticed sooner – SIGNS-for-Kids: developing an illness recognition tool to connect home and hospital

Gilleland

Bayfield²,

Bayliss

et al. 2019

BMJ Open Qual

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BackgroundDelays to definitive treatment for time-sensitive acute paediatric illnesses continue to be a cause of death and disability in the Canadian healthcare system. Our aim was to develop the SIGNS-for-Kids illness recognition tool to empower parents and other community caregivers to recognise the signs and symptoms of severe illness in infants and children. The goal of the tool is improved detection and reduced time to treatment of acute conditions that require emergent medical attention.MethodsA single-day consensus workshop consisting of a 17-member panel of parents and multidisciplinary healthcare experts with content expertise and/or experience managing children with severe acute illnesses was held. An a priori agreement of ≥85% was planned for the final iteration SIGNS-for-Kids tool elements by the end of the workshop.ResultsOne hundred percent consensus was achieved on a five-item tool distilled from 20 initial items at the beginning of the consensus workshop. The final items included four child-based items consisting of: (1) behaviour, (2) breathing, (3) skin, and (4) fluids, and one context-based item and (5) response to rescue treatments.ConclusionsSpecific cues of urgent child illness were identified as part of this initial development phase. These cues were integrated into a comprehensive tool designed for parents and other lay caregivers to recognise the signs of serious acute illness and initiate medical attention in an undifferentiated population of infants and children. Future validation and optimisation of the tool are planned.

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“…A recent study found the incidence of bacterial meningitis in young infants to be around 0.38 per 1,000 live births and is associated with a significant case fatality rate of 8% [16] . A study reported 23% of the survivors had serious CNS complications [17] . The clinical manifestations of the disease are diversified, clinical diagnosis is difficult, and the onset is rapid and progresses rapidly.…”

Section: Discussionmentioning

confidence: 99%

The correlation between MRI findings and clinical prognosis in children with purulent meningitis

Kong

Guo

et al. 2019

Preprint

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Background: To explore the correlation between magnetic resonance imaging (MRI) findings and clinical prognosis in children with purulent meningitis. Methods : Forty-nine cases of children with purulent meningitiswere collected from January 2016 to December 2018 in Beijing Children's Hospital. According to the Glasgow Outcome Scale（GOS), there were 35 patients with good prognosis and 14 patients with poor prognosis. All patients were scanned by MRI. We used Chi-square test and Logistic regression to analyse the correlation between MRI features and clinical prognosis in children with purulent meningitis. Results : Among the two groups, the poor prognosis group had the worst imaging performance, while the good prognosis group had the lighter imaging performance. Chi-square test showed that the imaging signs of cerebral edema, cerebral hemorrhage, subdural effusion, hydrocephalus, venous sinus thrombosis, cerebral hernia had statistical significance between the two groups (P < 0.05). Multivariate logistic regression analysis showed that the signs of cerebral edema, subdural effusion were risk factor for poor prognosis (P < 0.001). Conclusion : There are many complications and sequelae in children with purulent meningitis. The MRI findings of cerebral edema, cerebral hemorrhage, subdural effusion, hydrocephalus, venous sinus thrombosis, cerebral hernia suggest poor prognosis. It is instructive to clinical treatment and prognosis.

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Clinical Characteristics and Risk Factors for Poor Outcome in Infants Less Than 90 Days of Age With Bacterial Meningitis in the United Kingdom and Ireland

Cited by 28 publications

References 40 publications

Assessment of healthcare delivery in the early management of bacterial meningitis in UK young infants: an observational study

Assessment of healthcare delivery in the early management of bacterial meningitis in UK young infants: an observational study

Severe illness getting noticed sooner – SIGNS-for-Kids: developing an illness recognition tool to connect home and hospital

The correlation between MRI findings and clinical prognosis in children with purulent meningitis

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