G76. INCIDENCE AND OUTCOME OF POST-MENINGITIC HYDROCEPHALUS

K. Vijayakumar¹, J.R. Edwards, P. Prabhakar¹, I.K. Pople¹, P.J. Murphy², P.M. Sharples¹.

¹ Department of Paediatric Neurology, Frenchay Hospital, Bristol; ² Paediatric Intensive Care Unit, Bristol Royal Hospital for Sick Children, UK

Introduction: Historically 1.9–2.8% of children developed hydrocephalus following bacterial meningitis. The changes in incidence and outcome of post-meningitic hydrocephalus with modern pediatric intensive care unit (PICU) management of meningitis have not been clearly defined.

Methods: A regional PICU database, incorporating clinical, radiological and outcome (Glasgow outcome score (GOS)) data of all admissions (1997–2001) for severe bacterial meningitis (n=129) was interrogated and cross-referenced with all records of children undergoing treatment of post-meningitic hydrocephalus (n=11) in the regional pediatric neurosurgical unit from 1997–2001. Regional figures for all cases of bacterial meningitis in children (n=513) were obtained from the Communicable Disease Surveillance Center.

Results: Hydrocephalus requiring shunting complicated 2.1% of all cases of bacterial meningitis. Both early (p=0.018) and late (shunted) (p<0.001) hydrocephalus was significantly associated with young age (< 1 yr). In infants, hydrocephalus complicated significantly more cases of Group B Streptococcal (5/18; 29%) and pneumococcal (3/40; 7.5%) meningitis compared to meningococcal infections (2/119; 1.7%) (p=0.004). Overall 16% (13/81) of all imaged PICU meningitis patients had radiological evidence of early hydrocephalus of whom 4 (31%) required shunting; 2 of these had a poor neurological outcome (GOS 1–3). Neurological outcome in the entire shunted hydrocephalus population was poor (GOS 1–3) in 6/11 cases (55%).

Conclusions: Post-meningitic hydrocephalus occurs almost exclusively in the infant population, reflecting the poor compensatory reserve due to the underdevelopment of the CSF pathways in this age group. Despite modern PICU management the overall incidence of post-meningitic hydrocephalus remains unchanged. The development of hydrocephalus is associated with a poor neurological outcome.

G77. NEUROLOGICAL OUTCOME IN CHILDREN WITH NON-TRAUMATIC COMA ADMITTED TO A REGIONAL PAEDIATRIC INTENSIVE CARE UNIT

K. Vijayakumar¹, R. Knight^{1 …}