Okike IO, et al. - This paper strived to define initial characteristics of bacterial meningitis in young infants, in England. The purpose was to appraise the adequacy of individual case management, in comparison with relevant national guidelines and an expert panel review. The non–specific features related to bacterial meningitis did not exhibit any progression from onset to admission. Minor but prominent variations were reported in the proportion of infants with more specific symptoms at hospital admission compared with at the onset of the illness. This data underscored the difficulties in early detection by parents and healthcare professionals. Inappropriate prehospital and posthospital management was received by a significant number of infants. A targeted campaign for education and harmonisation of practice were put forth, with evidence–based management algorithms.

Methods

• The design of this study was a retrospective medical case note review and parental recall using standardised questionnaires.
• It was conducted in England and Wales.
• Infants aged <90 days with bacterial meningitis diagnosed between July 2010 and July 2013 were enrollled.

Results

• Among the 97 cases, 66 (68%) were admitted from home and 31 (32%) were in hospital prior to disease onset.
• Nearly all symptoms reported by parents appeared at the onset of the illness, with very few new symptoms appearing subsequently.
• 20/66 (30%) infants were investigated to have received inappropriate prehospital management.
• The median time from onset of first symptoms to first help was 5 hours (IQR: 2-12) and from triage to receipt of first antibiotic dose was 2.0 hours (IQR: 1.0-3.3), considerably shorter in infants with fever or seizures at presentation compared with those without (1.7 (IQR: 1.0-3.0) vs 4.2 (IQR: 1.8-6.3) hours, p=0.02). 26 (39%) infants exhibited a poor outcome with regard to death or neurological complication.
• The only prominent, independent risk factor (OR, 7.9; 95% CI 2.3 to 207.0) was seizures, at presentation.
• The median time from onset to the first dose of antibiotics was 2.6 (IQR: 1.3-9.8) hours for hospital cases, and 12/31 (39%) of infants had serious neurological sequelae at hospital discharge.
• Hearing test was not conducted in 23%.
• If carried out, it was delayed by ≥4 weeks in 41%.