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Research code: IR.IUMS.FMD.REC.1399.644
Ethics code: IR.IUMS.FMD.REC.1399.644
Clinical trials code: IR.IUMS.FMD.REC.1399.644

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Jafarnejad S, erfani L, Khoshnezhad Ebrahimi H, rezai M, Esmaeilian S. Validity of Criteria for Bacterial Meningitis in Children with Fever 28 to 56 days. RJMS 2024; 31
URL: http://rjms.iums.ac.ir/article-1-7975-en.html
Iran University of Medical Sciences , leilaerfani@gmail.com
Abstract:   (170 Views)
Introduction: Bacterial meningitis is an acute inflammatory phenomenon of the central nervous system, which is considered an emergency from the medical point of view, and if it is not diagnosed and treated, it will be associated with high mortality. It has been reported that it decreases with increasing age up to 25 years old. The complications of these diseases are relatively common and include blindness, deafness, neurological disorders, decreased level of consciousness, mental retardation, and paralysis. The death rate of bacterial meningitis is still high. Early diagnosis and treatment of bacterial meningitis can prevent serious complications. The diagnosis of bacterial meningitis is based on the combination of clinical and laboratory symptoms. Early treatment of bacterial meningitis can prevent serious complications such as hearing loss, memory problems, learning disorders, brain damage, seizures, and death. The diagnosis of bacterial meningitis is based on a combination of clinical and laboratory symptoms that indicate an inflammatory response in the cerebrospinal fluid. CSF).. Neonatal meningitis is divided into two categories, early and late, which are, respectively, due to the presence of signs of infection and isolation of the organism from cerebrospinal fluid culture in less than 72 hours or more than 72 hours of life. Analysis of cerebrospinal fluid through lumbar puncture is the most important laboratory diagnostic test. However, LP is invasive and painful and can pose challenges in its implementation and induce anxiety in the medical staff. This work is usually associated with side effects such as headache, back pain, and rarely with infection, brain herniation, and subdural, epidural, and spinal bleeding. The management of febrile infants aged 29 to 56 days in the emergency department has been discussed for decades. has taken. Although there is general agreement that these infants should have urine and blood tests, there is no such agreement for CSF testing. According to the said material, in this study we decided to take a step towards improving the sensitivity and specificity of diagnoses by examining and evaluating the accuracy of bacterial meningitis criteria in children who have undergone LP, which ultimately leads to more effective treatment and significant improvement. The quality of life of patients can be taken away.
Methods: In this descriptive-analytical study, the accuracy of bacterial meningitis criteria was investigated in low-risk children with fever of 28 to 56 days who underwent LP in the period of 2015 to 2019 at Hazrat Ali Asghar Hospital. After obtaining the necessary agreements, the approval of the ethics committee and permission to access the files were received from the hospital management. The information was completed through a checklist related to the criteria of bacterial meningitis and according to the files of the referring patients. The study questionnaire includes age, sex, gestational age, patient's appearance, history of chronic diseases and length of stay in NICU, history of antibiotic use in the last 72 hours, white blood cell count, tuberculosis band percentage, and LP test result. Completed questionnaires were randomly selected and analyzed from 73 checklists. It should be noted that the checklist was designed according to related articles and with the consultation and opinion of professors of Iran University of Medical Sciences. The implementation limitations of the plan included the time-consuming completion of the questionnaires and the incompleteness of the files and cases of loss to follow-up. After completing the data collection, the data were entered into SPSS and analyzed.
Examining  the accuracy of bacterial meningitis criteria: Using the central limit theorem and the finiteness of the mean and standard deviation, as well as the large number of observations, it was assumed that the data distribution was normal. Therefore, we no longer used common tests such as Kolmogorov-Smirnov, Anderson-Darling, etc. to check the normality of distributions. Because the predictor variables were quantitative or at least converted to quantitative and the response variable (LP) was also quantitative, we used multivariate regression design for data analysis. Of course, it is important that the linearity of the data was ensured before performing the regression method. This method was used to investigate the effect of LP on other mentioned cases with the aim of checking the accuracy of bacterial meningitis criteria in children with fever of 28 to 56 days who underwent LP in Hazrat Ali Asghar Hospital between 2015 and 2019. Considering that a suitable linear relationship was seen to express the relationship between the predictor variable and the response variables, we used linear regression transformations and obtained the results in a table. According to the obtained results, we found that the criteria for bacterial meningitis in febrile children can be defined under the components (38-week-old children, no long stay in NICU, negative AB, no evidence of infection on examination, normal CXR, no chronic medical problem, LP negative) modeled and obtained the optimal model.
Findings: SPSS version 22 software was used for statistical analysis of data. The results for quantitative variables were expressed as mean and standard deviation (Mean ± SD) and for categorical qualitative variables as percentage. Comparison between quantitative variables was done by t-test, and in case of non-normal distribution, using Mann-Whitney U test. Chi-Square Test and Fisher's Exact Test were used to check the relationship between qualitative variables. A significance level of less than 0.05 was considered.
In this study, among 84 patients, 57.14% of the patients studied were boys and 76.2% of the patients were born at a gestational age of more than 37 weeks. 88% of the patients had a happy appearance, and none of the patients had evidence of infection during the examination, and the results of the chest x-ray were reported to be normal in 98.8% of the patients. 81% of patients did not experience prolonged NICU stay and LP result was negative in all patients.
Conclusion: Considering that most of the patients looked happy and none of the patients had evidence of infection in the examination and these findings were consistent with the laboratory evidence, therefore, it is recommended not to perform LP in patients with this clinical picture.
Key words: Validity of Criteria  ، bacterial meningitis, fever, children aged 28 to 56 months

Type of Study: Research | Subject: Pediatric Disease

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