INVESTIGATION

1) Full blood count – infections

• Leukocytosis
• Total white cell count, neutrophils,
lymphocytes
2) Random blood sugar – hypoglycemia
3) Culture & sensitivity of blood/urine–
causative organisms
4) UFEME/urinalysis - UTI
5) Lumbar puncture – CSF analysis
6) Chest X-ray & Mantoux test – exclude
Tuberculous Meningitis
7) Brain CT – other pathologies (brain
haemorrhage, brain abscess)
 LUMBAR PUNCTURE

MUST BE DONE STRONGLY RECOMMENDED

• Any signs of intracranial infection • Age <12 months old (children

• Persistent lethargy and not fully younger may illicit subtle
interactive 6 hours after seizure symptoms of meningitis)
• First complex febrile seizure
WHAT TO LOOK FOR?
TREATMENT
Febrile seizure

1. Reassurance
• To counsel parents about the nature of febrile
seizure
2. Fever
• Antipyretic i.e. syrup or rectal Paracetamol
15mg/kg 6 hourly
• Or tepid sponging
• Avoid excessive clothing
3. Advise parents on First Aid
Measures during a Seizure (fit
education)
a) Stay calm during onset
b) Loosen clothes especially around
neck
c) Left lateral position
d) Do not insert anything into
mouth
e) Wipe any secretions from mouth
f) Time the duration, if >5 mins,
bring to clinic/hospital.
g) During fever, give PCM/tepid
sponging, encourage fluids
intake and ensure good aeration.
4. Rectal Diazepam
• For children with high risk of recurrence
• 0.5 mg/kg
• Advise parents how to administer if seizures
last > 5 minutes
TREATMENT
Meningitis

Fever and symptoms & signs of bacterial

meningitis
Lumbar puncture

• Do blood, urine C&S

• Start antibiotics +/- Dexamethasone
Use of steroids to decrease the sequelae:
 if CSF is turbid and patient not received prior
antibiotics
 Best efect achieved if given before/with first abx
dose
 0.15 mg/kg 6 hourly for 4 days, or
 0.4 mg/kg 12 hourly for 2 days
 Antibiotics administration accordingly

Improvement No improvement

Complete As evidenced by:

treatment • Persistent fever >72 hours
• Neurological deficit (rule out
various causes)

• Consider brain CT
Change antibiotics • Repeat LP if no evidence of
increase ICP

Response – complete course No response – TB, fungus or

encephalitis
Supportive measures
1. Monitor vital signs 4 hourly
2. Strict input/output chart.
3. Keep NBM if patient unconscious.
4. Careful fluid balance – maintenance IV fluids is
sufficient.
5. Seizure chart.
6. Daily neurological assessment.
7. If frontanel is still open, note head circumference
daily.
8. If therapy has been stopped, do 24 hour-observation
• If no complication, can discharge
If persistent fever despite treatment:
a) Thrombophlebitis at injection sites
b) Intercurrent infections
c) Resistant organisms
d) Subdural effusion, empyema or brain abscess
e) Antibiotic fever
Long term follow up
until child shown to have normal development (4 y/o)

• Note development of child at home and

school.
• Note head circumference.
• Any occurrence of fits or behavioural
abnormalities.
• Assess vision, hearing, speech.
• Request for early formal hearing assessment if
proven meningitis.
TREATMENT
Encephalitis
Management is supportive, usually require ICU admission

1. Monitor the intracranial pressure

2. Antibiotics / Antiviral – depends on the cause

3. Antiepileptic drugs – if seizure occur

PREVENTION
Febrile seizure
Excellent prognosis
• No evidence of permanent neurological
deficits following events.
Meningitis
• Vaccines (N. meningitides, S. Pneumonia,
Haemophilus influenza type B)

Encephalitis
• Vaccination – varicella & influenza for mothers
with genital herpes (HSV-2) undergoing LSCS.
REFERENCE
1. Nelson Essentials Of Pediatrics (7th edition)
2. Illustrated Textbook of Paediatrics (4th
edition)
3. Paediatric Protocols for Malaysian Hospitals
(3rd edition)