p.2
Antibiotic Therapy in Sepsis
What type of antibiotics should be initiated for septic shock?
Broad-spectrum antibiotics.
p.6
Vasoactive Medications in Shock Management
What effect does epinephrine have on serum lactate levels in neonates?
It is associated with increased serum lactate levels and the need for insulin due to hyperglycemia.
p.4
Empiric Antibiotic Regimens for Meningitis
What should be considered for suspected or confirmed neutropenia in sepsis?
Antipseudomonal beta-lactam +/- aminoglycoside and +/- vancomycin; consider antifungals.
p.1
Clinical Signs and Classification of Shock
What is the goal in compensated shock?
To 'clamp down' on the peripheral vasculature.
p.5
Antibiotic Therapy in Sepsis
What is the recommended dosage of doxycycline for tick-borne concerns?
2.2 mg/kg every 12 hours.
p.5
Clinical Signs and Classification of Shock
What vital sign indicates a critical condition in the patient HL?
Blood pressure of 56/34 mm Hg.
p.2
Vasoactive Medications in Shock Management
What is the purpose of crystalloid fluids and vasoactive medications in septic shock?
To provide cardiovascular support.
p.6
Vasoactive Medications in Shock Management
Which vasopressors are preferred in children with septic shock?
Epinephrine and norepinephrine are preferred over dopamine.
p.3
Fluid Resuscitation Protocols
How is the 4-2-1 method used to calculate maintenance fluids?
4 mL/kg/hr for the first 10 kg, 2 mL/kg/hr for the second 10 kg, and 1 mL/kg/hr for each kilogram above 20 kg.
p.4
Antibiotic Therapy in Sepsis
When should antibiotics be administered in cases of sepsis-associated organ dysfunction without shock?
As soon as possible after appropriate evaluation, within 3 hours after detection.
p.4
Empiric Antibiotic Regimens for Meningitis
What is the treatment for encephalitis suspected to be caused by HSV?
Acyclovir 20 mg/kg every 8 hours for age < 3 months; 10-15 mg/kg every 8 hours for age ≥ 3 months.
p.1
Clinical Signs and Classification of Shock
Why are bedside clinical signs not recommended in isolation for categorizing septic shock in children?
Due to inaccurate identification of children with cardiac dysfunction.
p.1
Fluid Resuscitation Protocols
What is the intended duration for intraosseous access?
Less than 24 hours, with further attempts at peripheral IV access recommended.
p.6
Vasoactive Medications in Shock Management
What should be considered for myocardial dysfunction with low cardiac output?
Consider epinephrine for decompensated shock.
p.6
Vasoactive Medications in Shock Management
What should be the approach when instituting vasopressor therapy?
The dose should always be initiated at the low end of the range and titrated to achieve desired mean arterial pressure (MAP) for age.
p.3
Antibiotic Therapy in Sepsis
What additional cultures should be considered in septic patients?
Cultures from IV catheters in place for >48 hours, CSF, urine, wounds, and respiratory secretions based on clinical presentation.
p.4
Empiric Antibiotic Regimens for Meningitis
What should be administered to infants older than 28 days with suspected sepsis?
Ceftriaxone 50 mg/kg every 24 hours +/- vancomycin; if penicillin allergy, use meropenem or alternatives.
p.1
Fluid Resuscitation Protocols
What is a resuscitation bundle?
A protocolized approach that has been shown to reduce in-hospital mortality when implemented.
p.8
Vasoactive Medications in Shock Management
Why might 'push-dose pressors' be preferred over continuous infusions?
They do not require a pump or specialized IV tubing and provide quicker hemodynamic improvement.
p.7
Vasoactive Medications in Shock Management
What is a common misconception about vasopressor administration?
That vasopressors must be administered through a central line rather than a peripheral line.
p.2
Fluid Resuscitation Protocols
What is the recommended fluid bolus for health care systems with intensive care availability?
40–60 mL/kg in bolus fluid within the first hour.
p.2
Fluid Resuscitation Protocols
What is the goal of continued reassessment during fluid resuscitation?
Achieving normal blood pressure for age and capillary refill time less than 3 seconds.
p.3
Fluid Resuscitation Protocols
What method is often used for fluid administration in pediatric resuscitation?
The 'push-pull method' using a 20 mL syringe, stopcock, and tubing.
p.1
Management of Pediatric Sepsis and Meningitis
Why is early screening for sepsis important?
Earlier recognition equates to more timely therapy, which is associated with improved morbidity and mortality.
p.1
Fluid Resuscitation Protocols
What should be done if peripheral vascular access cannot be readily obtained in a child with compensated shock?
Establishment of intraosseous access is warranted.
p.7
Vasoactive Medications in Shock Management
What is the relationship between blood pressure, cardiac output, and systemic vascular resistance?
Blood pressure is the product of cardiac output (CO) and systemic vascular resistance (SVR).
p.7
Vasoactive Medications in Shock Management
What are the MAP goals for different age groups?
0–12 months: 40–55 mm Hg, 1–3 yrs: 45–60 mm Hg, 3–5 yrs: 50–70 mm Hg, 5–10 yrs: 55–75 mm Hg, 10–14 yrs: 60–75 mm Hg, 14 yrs or older: 65–75 mm Hg.
p.10
Vasoactive Medications in Shock Management
What should be considered when administering a loading dose of milrinone?
It is optional due to hypotension but not recommended; if given, a concomitant fluid bolus is recommended.
p.9
Vasoactive Medications in Shock Management
What is the loading dose for milrinone?
50 mcg/kg over 10–60 minutes (optional).
p.12
Meningitis in Pediatric Patients
Why is pediatric meningitis considered a medical emergency?
It has 100% mortality if untreated.
p.5
Antibiotic Therapy in Sepsis
What is the purpose of adding doxycycline in treatment?
For expanded coverage to treat both susceptible and resistant pathogens.
p.5
Antibiotic Therapy in Sepsis
What is the significance of administering the broadest spectrum antibiotic first?
To treat the most likely pathogen effectively.
p.2
Management of Pediatric Sepsis and Meningitis
What is the first step in managing septic shock?
Blood culture attainment.
p.2
Fluid Resuscitation Protocols
What is the weak recommendation for initial resuscitation fluids according to 2020 pediatric guidelines?
Lactated Ringer's (LR) over Normal Saline (NS).
p.6
Fluid Resuscitation Protocols
What happens for each additional hour of persistent shock beyond 60 minutes without vasopressor initiation?
There is a two-fold increase in odds of mortality.
p.6
Vasoactive Medications in Shock Management
What is the role of norepinephrine in compensated shock?
It is used to increase systemic vascular resistance (SVR).
p.6
Vasoactive Medications in Shock Management
How do maturational differences affect adrenergic receptor stimulation in neonates?
There is predominance of vascular α-adrenergic receptor stimulation at low to medium doses of dopamine.
p.3
Antibiotic Therapy in Sepsis
When should antibiotics be administered in cases of septic shock?
As soon as possible, ideally within 1 hour after detection.
p.4
Antibiotic Therapy in Sepsis
Why are antibiotics crucial in treating sepsis?
They target the underlying cause of the infection, unlike other therapies that only address symptoms.
p.4
Empiric Antibiotic Regimens for Meningitis
What is the recommended treatment for toxin-mediated reactions like toxic shock syndrome?
Add clindamycin 13.3 mg/kg every 8 hours.
p.8
Vasoactive Medications in Shock Management
What is the maximum single dose reported for 'push-dose pressors' in adults?
10 – 20 mcg administered every 2 to 5 minutes.
p.5
Fluid Resuscitation Protocols
What should be administered first when co-administering medications?
Medications that can be pushed or administered quickly.
p.2
Fluid Resuscitation Protocols
What should be monitored to avoid fluid overload during resuscitation?
Signs of fluid overload such as worsening respiratory status and pulmonary edema.
p.2
Fluid Resuscitation Protocols
What complications are associated with Normal Saline (NS) in adults?
Hyperchloremic metabolic acidosis, systemic inflammation, acute kidney injury, coagulopathy, and increased mortality.
p.3
Antibiotic Therapy in Sepsis
What should be obtained prior to antibiotic treatment?
At least 2 sets of blood cultures (aerobic and anaerobic).
p.4
Antibiotic Therapy in Sepsis
What factors should be considered for empiric therapy in sepsis?
1) Broad coverage for probable microbes, 2) Clinical history, 3) Recent hospitalization, 4) Recent antibiotic exposure, 5) Drug allergies.
p.1
Clinical Signs and Classification of Shock
What are the signs of decompensated shock?
Delayed, thready pulse, cold extremities, long capillary refill time, and mottled appearance.
p.8
Vasoactive Medications in Shock Management
What is the typical code dose of epinephrine for pediatric patients?
0.01 mg/kg, with a maximum of 1 mg.
p.7
Vasoactive Medications in Shock Management
How can blood pressure be augmented?
By increasing heart rate via β-1 adrenergic receptors and/or increasing SVR via α-1 adrenergic receptor mediated vasoconstriction.
p.5
Antibiotic Therapy in Sepsis
In what settings should MRSA or ceftriaxone-resistant pneumococci be a concern?
In settings where they are prevalent.
p.5
Vasoactive Medications in Shock Management
What is the recommended ongoing blood pressure management for HL?
Norepinephrine IO 0.1 mcg/kg/min.
p.2
Fluid Resuscitation Protocols
How should fluid therapy be tailored for septic shock patients?
Based on clinical markers of cardiac output.
p.6
Fluid Resuscitation Protocols
What is the impact of timely initiation of resuscitation within the first 60 minutes?
It is associated with decreased length of ICU stay and mortality.
p.3
Antibiotic Therapy in Sepsis
What is associated with increased mortality in septic patients?
Delays in antibiotic therapy.
p.4
Empiric Antibiotic Regimens for Meningitis
What is the recommended treatment for intra-abdominal infections in sepsis?
Ceftriaxone 50 mg/kg every 24 hours + metronidazole 10 mg/kg every 8 hours.
p.1
Fluid Resuscitation Protocols
When is intraosseous (IO) access preferred over intravenous (IV) access?
In emergent situations where peripheral IV access cannot be achieved rapidly, such as in cardiac arrest or severe shock.
p.7
Vasoactive Medications in Shock Management
What did a large retrospective cohort study find regarding peripheral IV infiltration of vasoactive medications in pediatric patients?
The infiltration rate was only 2%, with no injuries or interventions required.
p.10
Vasoactive Medications in Shock Management
When is vasopressin used in pediatric sepsis?
As an adjunct to high dose norepinephrine if there is persistent hypotension and signs of warm shock.
p.9
Vasoactive Medications in Shock Management
What is the common dose titration for vasopressin?
0.1–0.5 milliunits/kg/min every 5 minutes.
p.12
Clinical Signs and Classification of Shock
What are HL's vital signs?
Heart rate: 180 bpm, BP: 67/46 mm Hg, RR: 54 breaths/min, SpO2: 97%, Temperature: 37.6°C.
p.13
Bacterial Etiology of Meningitis
What are the common organisms causing bacterial meningitis in neonates (0–1 month)?
Group B streptococcus, E. coli, and L. monocytogenes.
p.14
Clinical Signs and Classification of Shock
What is Cushing’s triad?
A late indicator of increased intracranial pressure, consisting of hypertension, bradycardia, and respiratory depression.
p.5
Clinical Signs and Classification of Shock
What does a capillary refill time of 4 seconds indicate?
Possible inadequate perfusion.
p.2
Fluid Resuscitation Protocols
What should be done if hypotension is present in a system without intensive care?
Administer 40 mL/kg in bolus fluid over the first hour.
p.6
Fluid Resuscitation Protocols
When should vasopressor initiation commence?
If there is continued poor perfusion despite 40-60 mL/kg of fluid resuscitation or development of fluid overload.
p.4
Empiric Antibiotic Regimens for Meningitis
What is the antibiotic recommendation for neonates with sepsis?
Ampicillin 75-100 mg/kg every 6-8 hours + gentamicin 4-5 mg/kg every 24 hours +/- vancomycin and acyclovir.
p.1
Fluid Resuscitation Protocols
What are the contraindications for intraosseous access?
Fractures or crush injuries near the access site, previous attempts in the same bone, and osteogenesis imperfecta.
p.8
Vasoactive Medications in Shock Management
What is a potential concern when administering a code dose of epinephrine?
Undesirable cardiac effects such as hypertension and tachycardia.
p.7
Vasoactive Medications in Shock Management
What precautions should be taken when administering vasoactive medications through a peripheral line?
Frequent nursing checks, prompt recognition of infiltration, use of a large bore vein via a small catheter, and having phentolamine readily available as an antidote.
p.11
Corticosteroid Use in Septic Shock
What are the proposed benefits of corticosteroids in septic shock?
1) Reduce norepinephrine reuptake 2) Augment calcium availability 3) Augment beta receptor in myocardium.
p.11
Vasoactive Medications in Shock Management
What alternative induction agents should be considered in the context of shock?
Ketamine or low dose fentanyl.
p.10
Vasoactive Medications in Shock Management
What is the risk associated with dopamine at 1–5 mcg/kg/min?
Risk for tachyarrhythmias (highest risk).
p.12
Clinical Signs and Classification of Shock
What does a heart rate of 180 bpm indicate in HL?
Tachycardia, which may suggest shock.
p.13
Bacterial Etiology of Meningitis
Which organisms are commonly implicated in bacterial meningitis for individuals aged 2–50 years?
N. meningitidis and S. pneumoniae.
p.14
Diagnostic Procedures for Meningitis
What laboratory tests are recommended for evaluating meningitis?
Blood culture, CBC with differential, platelet count, and inflammatory markers.
p.15
Diagnostic Procedures for Meningitis
What is the significance of isolating an organism on CSF culture?
It confirms the diagnosis of meningitis.
p.6
Vasoactive Medications in Shock Management
Why is dopamine more commonly used in neonates?
Due to its widespread use in literature, despite limited data on epinephrine and norepinephrine.
p.4
Empiric Antibiotic Regimens for Meningitis
What antibiotic is recommended for patients with asplenia?
Ceftriaxone 50 mg/kg every 24 hours; if penicillin allergy, use clindamycin or levofloxacin.
p.1
Clinical Signs and Classification of Shock
What are the signs of compensated shock?
Systolic blood pressure within normal range but signs of inadequate tissue perfusion, such as rapid capillary refill time and warm extremities.
p.1
Clinical Signs and Classification of Shock
What is the goal in decompensated shock?
To support the heart to pump blood to the periphery.
p.11
Vasoactive Medications in Shock Management
What did adult studies suggest about etomidate use in sepsis?
Higher mortality in patients who received etomidate for RSI.
p.10
Vasoactive Medications in Shock Management
What is a key characteristic of milrinone in pediatric sepsis management?
It augments cardiac output independent of β-adrenergic receptors.
p.9
Vasoactive Medications in Shock Management
In which situations might bolus dose epinephrine be particularly useful?
During peri-intubation, impending cardiac arrest, or in populations where additional fluid may cause harm, such as heart failure.
p.9
Vasoactive Medications in Shock Management
What is the common dose titration for dopamine?
5 mcg/kg/min every 5 minutes.
p.9
Vasoactive Medications in Shock Management
What is the common dose titration for dobutamine?
1–2 mcg/kg/min every 5 minutes.
p.12
Meningitis in Pediatric Patients
What is the incidence of pediatric meningitis in infants?
Highest incidence is in children less than 2 months of age.
p.13
Bacterial Etiology of Meningitis
What organisms are associated with bacterial meningitis in patients with head trauma?
S. pneumoniae, H. influenzae, and group A streptococci.
p.14
Diagnostic Procedures for Meningitis
What should be done before a lumbar puncture if elevated ICP is suspected?
A CT scan of the head should be performed to prevent brain herniation.
p.16
Diagnostic Procedures for Meningitis
What are the typical CSF findings indicative of meningitis?
CSF pleocytosis with a predominance of neutrophils, elevated CSF protein, decreased CSF glucose, and positive Gram stain.
p.17
Diagnostic Procedures for Meningitis
What tests are pending for the patient?
CSF culture and CSF Gram stain.
p.8
Vasoactive Medications in Shock Management
What is the dose used for 'push-dose pressors'?
1/10 of the code dose, typically 0.001 mg/kg or 1 mcg/kg.
p.11
Corticosteroid Use in Septic Shock
What risks are associated with corticosteroid use in septic shock?
1) Hyperglycemia 2) Hospital-acquired infection.
p.11
Vasoactive Medications in Shock Management
What is the controversy surrounding etomidate for rapid sequence intubation (RSI) in septic shock?
It may induce adrenal insufficiency and has been associated with increased mortality.
p.12
Empiric Antibiotic Regimens for Meningitis
What is the most appropriate management for HL based on her CSF analysis?
D. Ampicillin and gentamicin should be continued because the findings are suggestive of bacterial meningitis.
p.13
Risk Factors for Meningitis
What are some risk factors for bacterial meningitis in pediatrics?
Extremes of age, asplenia, immunocompromised status, not up to date with immunizations, and residing in dormitories.
p.14
Diagnostic Procedures for Meningitis
What is the purpose of a lumbar puncture in meningitis diagnosis?
To analyze cerebrospinal fluid (CSF) for diagnosis.
p.15
Management of Pediatric Sepsis and Meningitis
What are contraindications for performing a lumbar puncture?
Cardiopulmonary compromise, clinical signs of elevated ICP, papilledema, focal neurologic signs, skin infection over LP site.
p.16
Clinical Signs and Classification of Shock
What is the bacterial meningitis score used for?
To determine the probability of bacterial vs. nonbacterial meningitis in infants and children over 2 months.
p.18
Pathogen Specific Therapy for Meningitis
What is the first-line treatment for S. pneumoniae with a penicillin MIC less than 0.1 mcg/mL?
Penicillin G or ampicillin.
p.8
Vasoactive Medications in Shock Management
What is a common use for 'push-dose pressors' in clinical practice?
To manage transient hypotension during medical procedures.
p.8
Vasoactive Medications in Shock Management
What range of weight-based doses was reported in pediatric patients by Reiter et al.?
Mean: 1.3 +/- 1.1 mcg/kg (range 0.2 – 5 mcg/kg).
p.11
Corticosteroid Use in Septic Shock
When might corticosteroids be considered in pediatric patients?
If there is primary adrenal insufficiency based on patient history or clinical picture.
p.12
Management of Pediatric Sepsis and Meningitis
What is the risk associated with hypoglycemia during septic shock?
Poor long-term developmental outcomes.
p.13
Meningitis in Pediatric Patients
Which age group has the lowest incidence rate of bacterial meningitis?
Children aged 10–14 years with 0.05 per 100,000 population.
p.14
Clinical Signs and Classification of Shock
What are common clinical features of meningitis in older children?
Fever, headache, photophobia, confusion, vomiting, and neck stiffness.
p.17
Empiric Antibiotic Regimens for Meningitis
What is the empiric antibiotic regimen for a neonate with suspected bacterial meningitis?
Ampicillin and gentamicin.
p.17
Empiric Antibiotic Regimens for Meningitis
What is the recommended antibiotic regimen for patients aged 1-23 months with suspected meningitis?
Ceftriaxone and vancomycin.
p.19
Antibiotic Therapy in Sepsis
What is the treatment for Enterococci?
Ampicillin, with vancomycin if ampicillin resistant.
p.7
Vasoactive Medications in Shock Management
What is the typical use of epinephrine in shock management?
Continuous infusion for sustained hypotension and bolus for bradycardia or pulseless arrest.
p.10
Vasoactive Medications in Shock Management
What is the primary use of dobutamine in pediatric sepsis?
To be used only in the setting of myocardial dysfunction.
p.9
Vasoactive Medications in Shock Management
What is the benefit of bolus dose epinephrine in certain patients?
It is beneficial for patients who have failed traditional measures or experience rapid and profound hypotension.
p.12
Clinical Signs and Classification of Shock
What does the primary assessment of HL reveal about her airway and breathing?
Airway is clear; breathing is adequate with a respiratory rate of 54 breaths/min and SpO2 of 97%.
p.14
Clinical Signs and Classification of Shock
What are common clinical features of meningitis in infants?
Fever, irritability, poor feeding, bulging fontanelle, and lethargy.
p.14
Diagnostic Procedures for Meningitis
What CSF analysis is performed during a lumbar puncture?
CSF cell count and differential, glucose and protein concentration, and Gram stain and culture.
p.16
Clinical Signs and Classification of Shock
What factors contribute to the bacterial meningitis score?
Bacteria on CSF Gram stain, CSF protein greater than 80 mg/dL, peripheral ANC greater than 10,000 cells/mm³, CSF ANC greater than 1,000 cells/mm³, and seizure before or at presentation.
p.19
Corticosteroid Use in Septic Shock
What does the data suggest about dexamethasone's efficacy in neonates with meningitis?
Data does not suggest it provides benefit in neonates compared to older infants.
p.20
Management of Pediatric Sepsis and Meningitis
What is a proven effective prevention strategy for neonatal meningitis?
Intrapartum GBS prophylaxis.
p.11
Corticosteroid Use in Septic Shock
What do the 2020 pediatric guidelines suggest regarding IV hydrocortisone?
Against use if hemodynamic improvement is achieved with fluids + vasopressor therapy.
p.11
Vasoactive Medications in Shock Management
What were the findings of the pediatric study regarding etomidate and meningococcal sepsis?
Of 31 intubated children, 7 died after receiving etomidate compared to 1 death in those who did not.
p.10
Vasoactive Medications in Shock Management
What happens to endogenous vasopressin levels during septic shock?
Depletion can occur within hours, and repletion exogenously can improve hypotension.
p.9
Vasoactive Medications in Shock Management
What is the common dose titration for norepinephrine?
0.05–0.1 mcg/kg/min every 5 minutes.
p.9
Vasoactive Medications in Shock Management
What is the common dose titration for milrinone?
0.25 mcg/kg/min every 5 minutes.
p.12
Clinical Signs and Classification of Shock
What does a blood pressure of 67/46 mm Hg indicate?
Hypotension, which is concerning in the context of septic shock.
p.13
Meningitis in Pediatric Patients
What is the bacterial meningitis incidence rate for children aged 0–4 years?
0.48 per 100,000 population.
p.13
Bacterial Etiology of Meningitis
What organisms are commonly found in CSF shunt-related bacterial meningitis?
Coagulase-negative staphylococci, S. aureus, and aerobic Gram-negative bacilli.
p.16
Diagnostic Procedures for Meningitis
How can pretreatment blood cultures and CSF findings help in diagnosing meningitis?
They can help distinguish the diagnosis despite CSF cultures and Gram stain being affected by pretreatment antibiotics.
p.16
Management of Pediatric Sepsis and Meningitis
What vital signs were recorded for HL?
Heart rate: 180 beats/min, Blood pressure: 67/46 mm Hg, Respiratory rate: 54 breaths/min.
p.18
Pathogen Specific Therapy for Meningitis
What should be considered when treating E. coli and other Enterobacteriaceae?
Ceftriaxone, with susceptibility guiding specific antimicrobial choice.
p.19
Antibiotic Therapy in Sepsis
What should be used for Methicillin-susceptible S. aureus (MSSA)?
Nafcillin or cefazolin, but cefazolin should not be used for meningitis due to inadequate CNS penetration.
p.20
Corticosteroid Use in Septic Shock
When should corticosteroids be administered for pediatric pneumococcal meningitis?
If commenced with or before antibiotic therapy, ideally 10-20 minutes before or with the first antibiotic dose.
p.20
Corticosteroid Use in Septic Shock
What should be done if antibiotic administration has already commenced in adults with suspected pneumococcal meningitis?
Dexamethasone should not be administered.
p.10
Vasoactive Medications in Shock Management
What effect does epinephrine at less than 0.1 mcg/kg/min have on lactate clearance?
It hinders lactate clearance as a marker of resuscitation efforts.
p.9
Vasoactive Medications in Shock Management
What are the common dose titrations for epinephrine?
0.05–0.1 mcg/kg/min every 5 minutes.
p.12
Management of Pediatric Sepsis and Meningitis
What initial treatments has HL received?
Rectal acetaminophen, 3 LR boluses, ampicillin, gentamicin, and epinephrine.
p.13
Vaccination and Meningitis
What impact did the introduction of H. influenzae and S. pneumococcus vaccinations have on bacterial meningitis cases?
It resulted in a decline in the number of cases since the late 1990s, except in populations less than 2 months of age.
p.14
Clinical Signs and Classification of Shock
What are Kernig’s and Brudzinski’s signs?
Kernig’s sign is pain elicited by flexing the hip and extending the knee; Brudzinski’s sign is flexion of the hips when the neck is passively flexed.
p.14
Empiric Antibiotic Regimens for Meningitis
Which bacteria are most likely to be visualized on Gram stain in meningitis cases?
S. pneumoniae (90% positive) and H. influenzae (86% positive).
p.16
Diagnostic Procedures for Meningitis
What conditions warrant neuroimaging before a lumbar puncture (LP)?
Immunocompromised status, altered mental status, papilledema, focal neurologic deficit, history of hydrocephalus, presence of CSF shunt, recent CNS trauma, prior neurosurgery, or space-occupying lesion.
p.16
Management of Pediatric Sepsis and Meningitis
When should antibiotics be initiated in suspected meningitis cases?
Ideally after obtaining CSF for analysis, guided by age and predisposing risk factors.
p.17
Empiric Antibiotic Regimens for Meningitis
What is the significance of a positive Gram stain in CSF analysis?
Indicates the need for expanded antibiotic coverage.
p.18
Pathogen Specific Therapy for Meningitis
What is the antibiotic regimen for L. monocytogenes?
Ampicillin or penicillin.
p.19
Corticosteroid Use in Septic Shock
What is the role of dexamethasone in bacterial meningitis treatment?
It reduces inflammatory response, decreasing cerebral edema and ICP.
p.20
Corticosteroid Use in Septic Shock
What are the IDSA recommendations for corticosteroid use in suspected/confirmed H. influenzae type b meningitis in children?
Corticosteroids may be considered, but their use in pneumococcal meningitis is controversial.
p.20
Management of Pediatric Sepsis and Meningitis
What is the significance of administering antibiotics at least 4 hours prior to delivery for neonatal meningitis?
It is crucial for effective prevention of infection.
p.13
Bacterial Etiology of Meningitis
What is a common organism found in post-neurosurgery bacterial meningitis cases?
Aerobic Gram-negative bacilli, including Pseudomonas aeruginosa.
p.16
Management of Pediatric Sepsis and Meningitis
What is the risk associated with delayed CSF sterilization after antibiotic therapy?
Increased risk for neurologic sequelae.
p.20
Management of Pediatric Sepsis and Meningitis
What agents are recommended for intrapartum GBS prophylaxis?
Penicillin (preferred), ampicillin, cefazolin, clindamycin, or vancomycin.
p.16
Management of Pediatric Sepsis and Meningitis
What treatment was given to HL after seizure activity was identified?
Phenobarbital 20 mg/kg was given IO with cessation of seizure activity.
p.18
Empiric Antibiotic Regimens for Meningitis
What is the antibiotic regimen for bacterial meningitis in patients with a basilar skull fracture?
Ceftriaxone + vancomycin.
p.19
Antibiotic Therapy in Sepsis
What should be used for ampicillin-resistant E. coli?
Ceftazidime, based on susceptibility profile.
p.20
Corticosteroid Use in Septic Shock
What is the recommended dosage of dexamethasone for pediatric patients?
0.15 mg/kg IV every 6 hours for 2-4 days.
p.19
Antibiotic Therapy in Sepsis
What is the treatment for Staphylococcus epidermidis?
Vancomycin, with the addition of rifampin for synergy if CSF sterility is not achieved.
p.19
Corticosteroid Use in Septic Shock
When should dexamethasone be administered in relation to antibiotic therapy?
It should ideally be given before initiating antibiotic therapy for efficacy.
p.20
Corticosteroid Use in Septic Shock
What was the outcome of the 2015 meta-analysis by Brouwer et al. regarding corticosteroids in pediatric patients with Hib meningitis?
Corticosteroids demonstrated a nonsignificant reduction in mortality but were associated with lower rates of severe hearing loss.
p.20
Corticosteroid Use in Septic Shock
What is the adult recommendation for dexamethasone in pneumococcal meningitis?
0.15 mg/kg (max 10 mg) every 6 hours for 2-4 days, administered 10-20 minutes before or simultaneously with the first antibiotic dose.
