Question:
My baby girl Eloise passed away on 18th December from pneumococcal septicemia. We took Eloise to the hospital on 2 occasions with classic symptoms of meningitis and septicemia as per the foundations card. This included mottled skin and a pinprick rash on her shoulder with high fever, listless and refusing food on the first presentation 11th dec. We were discharged with viral diagnosis with calpol. The fever did not come down despite calpol and brufen so we took Eloise back in when her temp spiked at 41. The mottling was present again and the pinprick rash despite this fading and seemingly blanching. Eloise had classic symptoms again but once more they tried to discharge us. We refused. Eloise deteriorated started vomiting with blood specks and had diarroeah. She did not really wake but no tests were performed despite begging and pushing. They did a urine test which showed protein. Following a 35 minute seizure they gave an antibiotic but told us bloods came back clear and the fit was febrile and nothing to worry about. We were not happy with that. Following this Eloise was refused access to PICU and placed on the ward where she deteriorated. After 37 hours, 2 seizures and septic shock And begging our little girl was admitted to PICU. It was too late. I know you probably cannot make comments about cases like this which are pending coroners inquiries and other inquests. My question is at what point, how many symptoms would you expect before medical professionals take some sort of action? The lumbar puncture was only mentioned when Eloise was too unstable to have it and treatment for septic shock only administered after being taken to picu despite it being confirmed earlier in the day. Can you also advise what the expected survival rate is if this is treated properly early? Sorry it's so long but thankyou for and clarity you can provide.
Answer:
Dr Saul Faust says:
I am extremely sorry for your loss and can only imagine what you and your family have been though in the past few months. As you rightly say in your email, the pending Coroner's case makes it extremely difficult to comment on the details in your letter. From what you write, it sounds too as if you may be waiting for answers to your questions from your hospital Chief Executive as the first step in the formal NHS complaints procedure. This is often a good way for the medical teams to be able to start to address your questions and provide you with the answers you need.
Your first question relates to what should have been recognised by the different doctors at different stages of Eloise's illness. The problem with septicaemia and meningitis is that in many cases it is often extremely hard to distinguish between very serious infections and more common non-serious illnesses. In order to help doctors make these decisions, NICE (the National Institute for Health and Clinical Excellence) have produced guidelines on "Feverish illness in children - Assessment and initial management in children younger than 5 years", which outline the key features doctors and health professionals should look for when assessing young children with fever. The guidelines are developed by a group that includes parent representatives as well as experts, and I hope that they might provide answers to some of your questions. The internet link is http://www.nice.org.uk/cg047. There is also a new NICE guideline on the specific management of meningitis in children that will be published later this year (2010). Finally, a very recent research paper published this month in the Lancet combined the information from 35 studies to try to work out whether specific features can be used to detect serious infection in children. Worryingly for parents and doctors, this study showed that although some symptoms such as a petechial (non-fading pinprick) rash or rapid breathing can be treated as "red warning flags" to prompt further assessment, no single feature or combination of features can rule out serious illness in all cases.
In answer to your second question, we do know that the earlier treatment for septicaemia is started the more likely children and adults are to survive, but as the new study in the Lancet has shown it can be extremely difficult in many cases to work out who has septicaemia in the early stages of the disease.
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Reply #1 on : Tue October 05, 2010, 20:53:50
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