Management of Suspected Meningococcal Disease in Children
Introduction
Meningococcal disease ranges from isolated meningitis to fulminant meningococcal septicaemia with rapid shock, DIC and multi‑organ failure. Early recognition and immediate, aggressive management in the ED reduce morbidity and mortality.
Care follows paediatric resuscitation principles (APLS/PALS) and must link with local sepsis, paediatric critical care and public‑health pathways (NICE NG240; NICE NG254; Resuscitation Council PLS 2025; UKHSA).
Immediate priorities (first minutes)
- Treat as a time‑critical emergency using APLS/PALS: airway, breathing, circulation.
- Simultaneously:
- Activate the resuscitation team and call paediatric anaesthetic/ICU early for suspected progressive invasive disease.
- Ensure full monitoring (ECG, SpO2, NIBP) and resuscitation capability.
- Establish vascular access-aim for two wide‑bore peripheral IVs.
- Insert intraosseous (IO) access quickly if IV cannot be achieved rapidly (≤90 seconds or after three attempts).
- Give oxygen for respiratory distress or hypoxaemia and prepare airway support if consciousness or ventilation is compromised.
- Start empiric IV antibiotics without delay-target administration within 1 hour of hospital arrival.
- Rapidly assess perfusion and consciousness and begin fluid resuscitation per local paediatric sepsis/PLS guidance.