Assessment of the Prognostic Factors for Abnormal Neurodevelopmental Outcomes in Children with Acute Bacterial Meningitis by Using RNDA Tool

Abstract

This observational follow up study was carried in the Department of Paediatrics, Institute of Child and Mother Health (ICMH), Matuail, Dhaka, during November 2016 to December 2017, to determine the prognostic factors for assessment of the prognostic factors for abnormal neurodevelopmental outcomes in children with acute bacterial meningitis by using RNDA tool. A total of 56 children with acute bacterial meningitis of age > 1month - 15 years admitted in the inpatient department were enrolled in this study. Most 34 (60.7%) of the children belonged to age <12 months and male to female ratio was almost 2:1. More than half (58.9%) children admitted >48hrs after onset of illness, 11(19.6%) children received previous treatment with antibiotics and most (85.7%) of the children had occurrence of seizures prior to admission. More than one third (39.3%) children had >100 cell count in their CSF. CSF glucose/ serum glucose ratio was found <0.2 in case of 8(14.3%) children. More than three fourth (78.6%) children had high protein in their CSF. Abnormal developmental outcome assessed by RNDA on follow ups. It was observed that gross motor development was mildly impaired in 6(12.0%), 8(16.3%) and 5 (11.6%) cases on 1st, 2nd and 3rd follow up respectively. Gross motor was moderately impaired in 4 (8.0%), 3 (6.1%) and 3 (7.0%) cases on 1st, 2nd and 3rd follow up respectively. Accordingly, fine motor was mild impaired in 5 (10.0%), 4 (8.2%) and 5 (11.6%) cases and moderately impaired in 2 (4.0%), 3 (6.1%) and 2 (4.7%) cases on 1st, 2nd and 3rd follow up respectively. Cognition was mild impaired in 11 (22.0%), 12 (24.5%) and 11 (25.6%) cases and moderately impaired in 4 (8.0%), 4 (8.2%) and 3 (7.0%) cases on 1st, 2nd and 3rd follow up respectively. Children found with any selective neurological complication or abnormal developmental outcome in at least one follow up was considered to be abnormal. Hypertonic muscle tone and exaggerated jerk was found in 2(3.8%) children. 5(9.6%) children had developmental regression on follow up. 3(5.8%) children had squint, 2 (3.8%) children had subdural effusion, 2 (3.8%) children had visual deficit, 6 (11.5%) children had hearing deficit and 4 (7.7%) children had afebrile seizures on follow up. One (11.1%) child with focal seizure and 6 (60.0%) children with hazy CSF colour had significantly (p<0.05) developed abnormal developmental outcome. Children under 12 months of age, children who received previous treatment with antibiotics, seizures prior to admission, high WBC count, hazy CSF colour and CSF glucose/ serum glucose ratio below 0.2 were significantly (p<0.05) associated with acute complications during hospital stay. Children with focal seizure and children with hazy CSF colour were significantly (p<0.05) associated to abnormal developmental outcome. Multivariate regression analysis showed no significant (p>0.05) association between acute complications and prognostic factors. Age under 12 months in adjusted OR 0.970 with 95.0% C.I 0.943 to 0.997, CSF leukocytosis in adjusted OR 0.99 with 95.0% C.I. 0.99 to 1.00) and CSF glucose/serum glucose ratio<0.2 in adjusted OR 15.23 with 95.0% C.I. 1.28 to 100.0 were significantly associated with abnormal developmental outcome in multivariate regression analysis.