© 2004 The Liverpool School of Tropical Medicine DOI: 10.1179/027249304225013402 Annals of Tropical Paediatrics (2004) 24, 133–140 Reprint requests to: Dr Sunit C. Singhi, Paediatric Emergency & Intensive Care Unit, Department of Paediatrics, PGIMER, Chandigarh 160012, India. Fax: +91 172 744401 / 745078; e-mail: drsinghi@glide. net.in/dr_singhi@yahoo.com Intensive care needs of children with acute bacterial meningitis: a developing country perspective SUNIT C. SINGHI, RAJAN KHETARPAL, ARUN K. BARANWAL & PRATIBHA D. SINGHI Advanced Paediatrics Centre, Department of Paediatrics, Postgraduate Institute of Medical Education and Research, Chandigarh, India (Accepted October 2003) Summary In view of very limited availability of paediatric intensive care (PIC) facilities in developing countries, it is important to define priorities and recognise children who might benefit most from PIC. The objective of this retrospective, descriptive analysis was to identify the clinical indicators for intensive care in children with acute bacterial meningitis (ABM). The study included 220 children aged between 1 month and 12 years with ABM admitted to the paediatric services of an urban, tertiary-care, teaching hospital in northern India from July 1993 to December 1996. Of these, 88 were transferred to the PICU by the primary physician, 59% were comatose (Glasgow coma score <8), 44% had raised intracranial pressure (ICP), 24% were in shock and 42% had respiratory distress/ failure. Seizures occurred during their illness in 64 children, 34 of whom had refractory status epilepticus. Endotra- cheal intubation was needed in 29 and ventilatory support in 19 children. Most of the life support measures were required during the initial 48 hours. Nineteen (22%) children died, 16 of whom were comatose on admission. Multiple system involvement was associated with higher mortality. There were no deaths among the children who were not transferred to the PICU. Children with ABM who have a Glasgow coma score <8, clinical signs of raised ICP, refractory status epilepticus, shock and/or respiratory compromise should be prioritised to receive PIC. Introduction Acute bacterial meningitis (ABM) is essen- tially a disease of young infants and children; 75% of all cases occur in children under 15 years of age. 1 It is associated with high rates of mortality and morbidity which have remained unchanged during past decades despite the availability of effective antibio- tics, more so in developing countries. 1,2 In a multi-centre study in India, the mean case fatality rate from ABM was 16%, 3 as was the case in our centre before intensive care services were established. 4 Most deaths occur during the 1st 24 hours, 5,6 before anti- biotics can have any significant impact. Provision of intensive care to children with ABM might buy time until antibiotics con- trol the infective process and adjuvant thera- pies improve the general condition. Indeed, standard textbooks recommend that every child with a complicated course, systemic or neurological, should be admitted to inten- sive care for observation until the course can be determined and the first several doses of antibiotics administered. 7 However, modern critical care has only recently become avail- able in developing countries and is still very limited. These recommendations cannot be practiced in most such countries where patient load far exceeds availability of PICU beds and there is therefore a need to prioritise.