Management: Specific

Vasoactive therapy in children not responding to fluid boluses should be governed by local guidelines and commenced on advice from a paediatric intensivist. Drugs such as adrenaline, noradrenaline, and dopamine are used and these can be commenced peripherally (or intraosseous) for a short period of time whilst establishing a central line.

Corticosteroids are not for use in children under 3 months old. Dexamethasone 0.15mg/kg QDS should be given for 4 days if lumbar puncture reveals [4]:

• Frankly purulent CSF
• CSF white blood cell count >1000/microlitre
• Raised CSF white blood cell count, with protein >1g/litre
• Bacteria on Gram stain

Seizures should be managed as per the APLS guidelines in a stepwise fashion [4].