Effect of malnutrition on immediate outcome of children admitted with acute bacterial meningitis in a tertiary level hospital

" Effect of malnutrition on immediate outcome of children admitted with acute bacterial meningitis in a tertiary level hospital." Author: Dr. Md.Maniruzzaman Place of the study:Department of Paediatrics, Mymensingh Medical College Hospital , Bangladesh. Type of study: Hospital based prospective cohort study. Duration of study : one year(from February 2012 to February 2013 ) Key words: Malnutrition, Acute bacterial meningitis, immediate outcome, children, tertiary level hospital. ABSTRACT Introduction: Acute bacterial meningitis is an important serious illness worldwide and causing mortality and morbidity in children. In developed countries , only 5% of patients die and 15-20% develop sequelae whereas in underdeveloped countries 12-50% of patients die and 25-50% of patients develop sequelae . Among the sequelae, hydrocephalus, quadriplegia/paresis, blindness, hemiparesis, monoparesis are more common. Malnutrition can make a person more susceptible to infection, and infection also contributes to malnutrition, which causes a vicious cycle. So the result of this study may help in better management of acute bacterial meningitis in children with malnutrition. Objective: general objective is to compare the immediate outcome of meningitis : in malnourished and well nourished children. And specific objectives are to compare Relative Risk(RR) of death, major neurological sequelae and minor neurological sequelae in malnourished children with acute bacterial meningitis to well nourished children Methods: A hospital based prospective comparison cohort study was conducted in the Pediatrics department of Mymensingh Medical College & Hospital from February 2012 to February 2013 to compare the outcome of meningitis : in malnourished and well nourished children. Thirty cases of acute bacterial meningitis with malnutrition and thirty cases of acute bacterial meningitis without malnutrition admitted in the department of Pediatrics of Mymensingh Medical College & Hospital were enrolled by purposive sampling. Necessary informations were collected by detailed history taking, clinical examination and close follow up of the hospital course, using pre-designed questionnaire. Main outcome measures: The main outcome variables are death , major neurological sequelae and minor neurological sequelae. Result: This study reveals Meningitis occur more in under five age group and in males in both group of children . In this study fever, convulsion, bulged fontanel , abnormal behavior, headache and respiratory symptoms were presenting complaints in majority of cases in both group and convulsion is significantly more in malnourished group . Fever , convulsion and sign of meningeal irritation/ bulged fontanelle are the most prominent clinical features . In Malnourished group GCS on admission was < 13 in majority whereas GCS is between 13 to 15 in well-nourished group at presentation . There is no significant diffrence in CSF findings in both groups. This study reveals that most of the exposed children has Haemoglobin level <10gm/dl. In this study immediate outcome of acute bacterial meningitis are death , major neurological sequel (Hydrocephalus, quadriplegia/quadriparesis, blindness) and minor neurological sequel (hemiparesis,monoparesis, mild motor delay , ataxia and sensory impairement). Total 12(20%) patient children died, 14(23%) patients developed major sequelae {9(15%) children developed hydrocephalus, 04(6.66%) children developed quadriplegia, 01(1.66%)children developed blindness,}, 10 (17%) patients developed minor sequelae { 02(3.33%) children developed hemiparesis, 04(6.66%) children developed monoparesis, 01(1.66%) children developed mild motor delay, 01(1.66%) children developed ataxia and 02(3.33%) children developed sensory impairement .}. Relative Risk(RR) of death is 5 fold in malnourished group, Relative Risk(RR) of Major sequel is 6 fold and Relative Risk(RR) of Minor sequelae is 4 fold in malnourished children suffering from acute bacterial meningitis. Average hospital stay is significantly more in malnourished group.Conclusion: Results of this study concludes that acute bacterial meningitis occur in all ages from 1 to 12 years child of both sexes and more in under five age group and in the males. . Fever , convulsion and sign of meningeal irritation/ bulged fontanel are the most prominent clinical features. Death, major neurological sequel(Hydrocephalus, quadriplegia/quadriparesis, blindness) and minor neurological sequel (hemiparesis,monoparesis, mild motor delay , ataxia and sensory impairement) are more common in malnourished children. Young age, male sex, anaemia, weight for age Z score <-2SD/ BMI <3rd percentile , GCS< 13 are the bad prognostic factors. For full text : contact with author : www.litonzaman13@gmail.com/+8801720559803/www.litonzaman.blogspot.com