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Should steroids be used in children with meningococcal shock?
  1. R G Branco,
  2. R R Russell
  1. Addenbrooke’s Hospital, Hills Road, Cambridge CB2 2QQ, UK;

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A 3 year old boy is admitted to a paediatric intensive care unit with a history of fever, non-blanching petechial rash, decreased conscious level, and grunting; capillary refill is poor. After screening for sepsis, antibiotics are started. He is intubated, receives fluid resuscitation (total of 100 ml/kg), and a central catheter is placed, showing a central venous pressure of 12 mm Hg. Despite dopamine infusion the attending physician is unable to stabilise his blood pressure, and he requires noradrenaline infusion to achieve and maintain his haemodynamic state.

Structured clinical question

In a child with meningococcal shock [patient group] does steroid replacement therapy [intervention] decrease mortality [outcome]?

Search strategy and outcome

Secondary (Cochrane library, 2004) and primary (Medline, Embase, Scielo) sources were included in the search. MeSH terms were used in Medline and Embase.

Search strategies: “meningococcal” AND “steroid replacement”; “meningococcal” …

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  • This case is based on experience from several cases. Details have been altered to ensure patient anonymity

  • Edited by Bob Phillips