Monitoring

In hospital

Monitor children and young people closely after admission to hospital for signs of deterioration; focus on:[9]

  • Respiration

  • Pulse

  • Blood pressure

  • Oxygen saturation

  • Glasgow Coma Scale score

    • In children unable to give a verbal response (in practice, those aged under 2 years), use the Glasgow Coma Scale with modification for children, or assess using focal neurological signs.[9]

Be aware that children and young people with bacterial meningitis (particularly meningococcal meningitis) can deteriorate rapidly regardless of the results of any initial assessment of severity.[9] See Bacterial meningitis in children.

In adults, involve intensive care teams early in patients with:[48]

  • Rapidly evolving rash

  • Evidence of limb ischaemia

  • Cardiovascular instability

  • Acid/base disturbance

  • Hypoxia

  • Respiratory compromise

  • Frequent seizures

  • Altered mental state.

Transfer patients to critical care if they:[48]

  • Have a rapidly evolving rash

  • Have a Glasgow Coma Scale score of ≤12 or drop of >2 points [ Glasgow Coma Scale Opens in new window ]

  • Require monitoring or specific organ support

  • Have uncontrolled seizures

  • Have evidence of sepsis.

Ensure all patients with meningitis and meningococcal sepsis receive input from an infectious disease or microbiology specialist.[48]

Long-term

Offer a formal audiological assessment as soon as possible, within 4 weeks of being fit to test, and preferably before discharge from hospital.[9]

If the child or young person has severe or profound deafness, offer an urgent assessment for cochlear implants as soon as they are fit to undergo testing.[9] See Assessment of hearing loss.

Ensure children and young people are reviewed by a paediatrician (with the results of their hearing test) 4-6 weeks after hospital discharge to discuss morbidities associated with their condition and be offered referral to appropriate services.[9]

Although formal testing for cognitive, academic, and behaviour problems is not generally necessary, it is important to monitor the child's progress over time. All patients should be reviewed once a year to detect any long-term complications.

As with all patients who survive bacterial meningitis, patients with meningococcal meningitis are at risk for long-term neurological sequelae.

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