This is an extract from the May issue of the Medical Protection Society’s case reports:

An eight week old infant was brought to the family’s doctor as mother became concerned about his general irritability and frequent crying lasting up to 2hrs. Symptoms were getting progressively worse over a 3 day period and not settling with breast feeding.

The baby had been born normal with no medical problems.

Doctor R who examined the baby, did not do a thorough check as the baby was asleep in a child seat. He did not want to wake him up. He told the mother that it was probably colicky episodes and recommended Infacol (Oral Suspension contains Simeticone – specially formulated to relieve infant colic and griping pain).

A few hours later the mother rang doctor R again as she became worried as the baby had missed 2 feeds and was either crying or sleeping. The doctor asked mum if there was any rash on the baby. Mother went back, checked the baby and told Dr. R that she could see no rash. The doctor reassured mum and said that the baby was probably suffering from a bad episode of colic. She told her to give him paracetamol for pain relief. No follow up appointment was suggested.

Four hours later the mother rang the emergency care doctor as the baby had not had a feed for the whole day and had become listless and was now whimpering rather than crying. The doctor asked the mum to bring the child back. He took a full history and did a thorough exam. He noted a full fontanelle, an altered level of consciousness and generalised lassitude. The temperature was 39.4 degs, heart rate 180 and respiration was shallow at 60 per minute. He rang for an ambulance immediately and sent the baby to the hospital.

E.coli meningitis was diagnosed. Although he appeared to respond to treatment initially, had a prolonged generalised seizure on day 2. He developed hydrocephalus and needed an intraventricular shunt on day 3.

At 12 months the baby showed marked delay in development. All milestones were delayed considerably indicating that life long dependency on carers would be required. Mother sued the doctor. A GP expert critised Dr.R for not examining the baby at 1st consultation and giving poor quality telephone advice when he was contacted again. The case was settled for a high sum.

Learning Points suggested by Medical Protection Society:

? Meningitis in infants may present with generalised non specific symptoms and signs like refusing to feed, irritable, bulging fontanelle, high pitched cry, fever, vomitting, raised heart and respiratory rate. May or may not have a petechial rash.
? Similar symptoms and signs may also be seen in other common childhood illnesses such as viral infections. It is therefore important to examine the infant thoroughly and followed up closely if febrile with or without a focus of infection.
? A willingness to consider a differential diagnosis was imperative (in this case) owing to the varied prodromal features of meningitis and a high index of suspicion is required.
? Absence of a rash did not mean that this was not a sick child.