Pediatric Meningitis
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þ Normal CSF values in infants and children
  <LP.TXT -pediatric>

þ LP in infants:
 - pre-oxygenate
 - lateral decubitus position for LP may cause hypoxemia (pulse ox < 85%) in
   infants 1-15 weeks (92% of non-preoxygenated infants in study, compared to
   11% if preoxygenated.)
   [Fiser DM, eet al.  Prevention of hypoxemia during lumbar puncture in
   infancy with preoxygenation.  Ped Emerg Care 1993; 9(2):81.]

þ Effects of previous antibiotics on meningitis presentation:
  [Rothrock SG, Green SM, et al.  Pediatric bacterial meningitis:  is prior
  antibiotic therapy associated with an altered clinical presentation? Ann
  Emerg Med 1992; 21(2):146-152.]  Retrospective.  Pretreated children have
  less frequent temps of 38.3øC, altered mental status, and longer duration of
  symptoms before diagnosis.  No change in incidence of nuchal rigidity or
  meningeal signs, mortality, or length of hospital stay.

þ Bandemia as indicator of meningitis:
  If immature:mature ratio (bands:segs; "I:T") is more than 0.12 (12%), at
  high risk for meningitis, and vice versa.  [Lembo RM, Rubin DH, Krowchuk DP,
  McCarthy PL.  Pediatric Emergency Care 1991;7:4.]

þ Dexamethasone for Pediatric Meningitis
 - Use, because prevents neuro sequelae.
   [Gelman BJ et al.  Dexamethasone and bacterial meningitis:  a meta-analysis
   of randomized controlled clinical trials.  West J Med 1992; 157(1):27.]
   No effect of Decadron on fatalities. Reduced nonauditory neuro sequelae
   (relative risk=2 at 6 weeks, 4 at six months) and reduced risk of bilateral
   hearing loss (RR=4) and subsequent need for hearing aids (RR=21).
 - May want to avoid, because steroids may make sepsis worse.  Does help
   prevent deafness in H. flu meningitis, but does little for pneumococcal
   meningitis and nothing for meningococcal meningitis.
   [Meningitis Working Party of the British Paediatric Immunology & Infectious
   Diseases Group. Should we use dexamethasone in meningitis?  Arch Dis Child
   1992; 67(11):1398.]
 - A recent large prospective study showed no benefit.
   [Wald ER. Dexamethasone therapy for children with bacteral meningitis.
   Pediatrics 1995;95:21.]

- Adjuvant corticosteroids may not reduce risk of death, length of
  hospital stays for children with bacterial meningitis, study suggests.

HealthDay (5/6, Edelson) reported that according to a paper appearing in
the May 7 issue of the Journal of the American Medical Association,
"[c]orticosteroids are increasingly used to help treat children with
bacterial meningitis." But researchers at the Children's Hospital of
Philadelphia also found "that adding the drugs to antibiotic treatment
may not reduce death rates or the length of hospital stays." The study,
however, "isn't the last word on the issue," because "the death rate
from the infection in children is so low that a real difference is
statistically hard to demonstrate," explained lead investigator Samir S.
Shah, M.D.

        For the study, the authors focused on some "2,780 children were
discharged with bacterial meningitis...from 27 U.S. tertiary care
children's hospitals" between 2001 and 2006, Medscape (5/6, Barclay)
added. The researchers found that "248 children (8.9 percent) received
adjuvant corticosteroids." But "[f]or any age group, adjuvant
corticosteroid therapy was not associated with reduced mortality," and
"[t]ime to hospital discharge was also unaffected by adjuvant
corticosteroid use."