Management Of Meningitis

In Pediatrics Patient
Abdul Aziz Bin Kahar Muzakkir
Anis Fasehah Binti Jamal
Nor Hazwani Binti Ahmad Tarmidi
Nur Amalina Binti Mohamad Jaafar
Normadia Binti Mahmud

LEARNING OBJECTIVE

To understand what is meningitis in paediatric patient.

To identify the possible causes of meningitis among

children.

To know the diagnostic procedure to investigate meningitis.

To carry out management of meningitis among paediatric.

To learn preventative measure against meningitis among

paediatric.

INTRODUCTION

Meningitis is inflammation of meninges inside of

the brain.

It is usually cause by bacterial and viral infection.

Meningitis also common in children and its cause

is vary according to their ages.

Mortality rate for meningitis among children

around 5% in developed country even after
widespread of vaccination (NSW Ministry of
Health, 2014).

ETIOLOGY
Meningitis in children can be caused by:
Bacteria
Immediately after birth : group B Streptococcus,
Escherichia coli, and Listeria species.
1 month of age : Streptococcus pneumoniae,
Haemophilus influenza type B (Hib), and Neisseria
meningitides.
Viral
Enterovirus (spread by direct contact with feces
during activities such as diaper changing or
indirectly through contaminated water, food, and
surfaces)

 Slow-growing organisms ( fungi and Mycobacterium

tuberculosis) develops over two weeks or more
cause chronic meningitis
Fungal- cause Cryptococcal meningitis that affect
people with immune deficiencies
Cancers
Head injury
Brain surgery
Drug allergic reactions.

PATHOPHYSIOLOGY

Most common entry of bacteria is the upper respiratory

tract or through hematogenous spread (bloodstream)

Bacteria also can invade the brain by direct spread of

pathogens from adjacent structures to the brain
(paranasal sinuses and middle ear and mastoid
sinuses)

Inoculation of pathogens may also result from direct

implantation by trauma in penetrating injuries and
compound skull fractures, following surgical procedures
and invasive diagnostic and therapeutic interventions

Bacteria colonize the mucosa of the nasopharynx and

invade the bloodstream through the epithelial cells
which initiates the meningitis.

In the bloodstream, the bacteria has to replicate and

survive the host's defences and gain access to the
CNS directly through the microvasculature or the
choroid plexus (a plexus of cells that produces the
cerebrospinal fluid in the ventricles of the brain)

The bacteria cross the blood-brain barrier and survive

and multiply in the CSF

Once the bacteria reside in the CSF, bacterial

multiplication is facilitated, as the CSF lacks several
of host defenses, including low levels of
immunoglobulins and complement.

CLINICAL MANIFESTATION

In new born / small infants

slow or inactive, or be irritable,vomiting, or be
feeding poorly, bulging fontanel

Child > 2 years old

Common: High fever, headache, and stiff neck
Other symptoms: nausea, vomiting, discomfort
looking into bright lights, confusion, and
sleepiness

Any ages
Seizures

COMPLICATION
Hearing loss (partial @ total)
Recurrent seizures (epilepsy)
Problems with memory and concentration
Co-ordination, movement and balance
problems
Learning difficulties & behavioral problems
Vision loss (partial @ total)
Spastic @ paralyzed muscles

DIAGNOSTIC TEST
1. Blood culture
To determine if any bacteria present and to identify the best
antibiotic will given
2. Lumbar puncture
To identify if any bacterial infection present and which
antibiotic will given
3. Imaging tests
Ct scan will be recommended before LP to help determine if
it is safe to perform the LP and to determine if other cond.
may be contributing to the childs symptoms (eg:- bleeding
or mass in the brain )

MEDICAL MANAGEMENT
Bacterial meningitis
Antibiotic :- started immediately after the blood
tests and LP done. Treatment is administered
intravenously. Oral antibiotics are no
recommended.

Viral meningitis
the is no medications can eliminate viral
meningitis, instead the treatment is given
support, provide adequate rest, plenty amount
of fluid / IV fluids, and medication to treat fever
and headache (eg: ibuprofen). Medication
should according to weight.

Health Education
Fluid management.
Suitable positioning to stabilize intracranial
pressure.
Follow antibiotic plan throughly.
Provide quiet and clean environment.

Opisthotonic position

NURSING MANAGEMENT

Diagnosis

Planning

Intervention

Acute pain
related to
headache
secondary
to
meningeal
irritation.

The child
will be
reduce
headache
and be
comfortable
as possible.

Assess pain with Provide ability to

age
quantify pain for future
(appropriate
comparison
pain scale)
Sensory stimulation
Minimize tactile increase discomfort
stimulation
then lead to increase
pain sensation
Allow the child
to be in
comfortable
position

Rational

The opisthotonic
position may be the
most comfortable

Dim light reduce the

Keep the light
discomfort from
dim and
photophobia. Noise can
maintain a quiet disturbed the child from
environment
rest to reduce the pain
Provide pain
medication as
prescribed by
the physician.

Pain medication is
appropriate for acute
discomfort for any
illness

Evaluation

Child will be
calm and
express
increased
comfort

Diagnosis

Planning

Intervention

Rational

Ineffective
tissue
perfusion
(cerebral)
related to
increase
intracranial
pressure

The child
will have
normal
intracranial
pressure

Monitor signs of
diminished tissue
perfusion( BP,
pulse)

To take quick action and An increase

prevent further
in cognitive
complications
and no sign
of increased
As a baseline data
intracranial
pressure

Monitor child vital

sign such as
temperature and
respiration every 4
hour.

To prevent more
Elevate head of bed increase in ICP
(30 degree)
Change in intracranial
Educate the family pressure will be able to
members to make
mislead the risk for
sure the child to
brain herniation
have total bed rest
If there is breathing
Place emergency
complications occur
equipment such as
oxygen and suction
near the childs
room

Evaluation

ISLAMIC INCULCATION
There is no disease that were created by Allah
has no cure except for the old age disease.
So, It is a job of men to find the cure and seek
medical treatment as best as they can.
Abu Hurayrah narrates that The Prophet S.A.W
said :
There is no disease that Allah has created except that
He
also has created its remedy (Bukhari 7.582)

CONCLUSION

Meningitis is a serious disease that can effect the

neurological function of the baby

Meningitis can be cause by bacterial and viral

infection.

If the baby not treated, they will have difficulty in

speaking, thinking and also hearing.

The child that diagnosed with meningitis need to be

treated immediately to avoid serious complication.

REFERENCES

Davis C. P. (2015). Meningitis in Children Causes, Symptoms, Treatment - Causes

of Meningitis in Children - eMedicineHealth. Published by Emedicinehealth.com.
Retrieved from
http://www.emedicinehealth.com/meningitis_in_children/page2_em.htm

Kaplan C. L. & Pentima C. D. Patient education: Meningitis in children (Beyond the

Basics). (n.d.). Published by UpToDate. Retrieved from
http://www.uptodate.com/contents/meningitis-in-children-beyond-the-basics

Lopes M.B.L. & Adesina M. A. Pathology of Bacterial Infections. (n.d.). Retrieved

from http://emedicine.medscape.com/article/1806579-overview#a2

Mayo Clinic Staff. (2016). Meningitis. Published by Mayo Clinic. Retrieved from
http://
www.mayoclinic.org/diseases-conditions/meningitis/symptoms-causes/dxc-201695
22

NSW Kids and Families. (2014, July 15). Infants and Children: Acute Management
of Bacterial Meningitis. North Sydney, New South