Neonatal Sepsis & Meningitis

Updated Admission Guidelines for pediatric meningitis/encephalitis at OCH

Objective: To improve evaluation for and acute monitoring of children with probable or confirmed bacterial meningitis who are admitted to Oishei Children’s Hospital.

Rationale: Children with bacterial meningitis or acute viral/bacterial encephalitis have a high probability of acute neurologic decompensation, with sequelae including permanent neurologic impairment, partial or complete cerebral herniation, or death.

Bacterial meningitis is often on the differential when evaluating well-appearing neonates with fever, but the clinical suspicion is often low. This guideline applies to children in whom the clinical suspicion for bacterial meningitis is moderate or high based on clinical or laboratory evaluation, or children with possible viral meningitis or other infectious or inflammatory neurologic processes with alterations in mental status at risk for adverse neurologic outcomes.

Hard criteria for PICU admission in suspected meningitis

1.       Altered mental status, including seizures or lethargy.

2.       Clinical or radiographic evidence of increased intracranial pressure

3.       Frank bacteria on Gram stain **if already known prior to ED dispo**

a.       Do not delay admission to wait for gram stain. Primary focus should be on clinical criteria.

b.       PICU could be called from the floor if gram stain returns positive after admission.

c.       Remember, it would be rare to have a case of bacterial meningitis with a child looking well enough for floor admission.

If stable in the first 12-24 hours in PICU, it is likely that they will transfer out to the floor (even if known to have bacterial meningitis). Likewise, if an infant/child is doing well on the floor and their CSF culture returns positive for bacteria, this does not necessitate PICU consult or transfer.

*This is a guideline, not a policy. Case by case assessment may happen for well-appearing children in times of extremely high clinical volume.  We anticipate that the majority of these children will be initially evaluated in the Emergency Department, but this guideline may also apply to patients who are admitted to the general inpatient floor if their status changes.

For Reference Only (not to be used as definitive “bacterial meningitis” criteria)

Source: UpToDate

*Check age references for WBC count

*Protein elevation may be due to bloody tap