Admission to a Pediatric Intensive Care Unit for Bacterial Meningitis: Review of 168 Cases

We performed a retrospective analysis of the charts of 168 patients (1 week to 17 years of age) admitted to a pediatric intensive care unit (PICU) with bacterial meningitis over an 11-year period (1980–1990) to delineate clinical characteristics and outcome. The four major reasons for PICU admission were an altered level of consciousness (70%), hemodynamic instability (33%), seizures (13%), and apnea (7%). Many children had more than one reason for admission to the PICU. The pathogens identified included Haemophilus influenzae type b in 71 (42%) patients, Neisseria meningitidis in 33 (20%), Streptococcus pneumoniae (SP) in 23 (14%), Group B Streptococcus (GBS) in 18 (11%), Escherichia coli in 7 (4%), and others in 7 (4%). Overall mortality was 13% (22 of 168); most deaths (12/22) occurred within 24 hours of admission. The highest mortality rate was associated with GBS meningitis (39%). Average duration of stay in the PICU was 2.9 days. Complications in the PICU included seizures (32%), hemodynamic instability (23%), hyponatremia (21%), syndrome of inappropriate antidiuretic hormone secretion (13%), disseminated intravascular coagulation (12%), and hypernatremia (6%). Ninety-five percent (138/146) of the survivors were evaluated between 1 month and 1 year after discharge: 79% had no significant neurological sequelae, 14% had mild sequelae, and 7% remained with major neurological sequelae. Moderate or severe hearing deficits were detected in 13% of those evaluated (13 of 102). Patients with SP and GBS meningitis had the highest incidence of complications, sequelae, and mortality. The majority of deaths due to bacterial meningitis, in a PICU, occur early, seem unavoidable, and result from neurological or hemodynamic dysfunction. The fact that the majority of survivors have a normal outcome despite a complicated course favors provision of close surveillance and aggressive management in a PICU setting.