Purpura > 2mm diameter (unless clinical picture suggestive of HSP).The unwell child (see above NBR treatment algorithm + ILL criteria).Indicators of meningococcal disease (or other serious bacterial infection) include: See this parent information leaflet for additional guidance on return advice *** ESSENTIAL PROCESS PRIOR TO DISCHARGE FROM RHC:Įnsure clear & appropriate indications for return advice given to child’s parent / guardian. Lethargy (as reported by family or other medical / nursing staff) 5, 15.Irritability (inconsolable crying or screaming).Prolonged Capillary Refill Time > 2 secs.Increasing systolic to diastolic difference in blood pressure.Tachypnoea +/- oxygen desaturation in air.Regardless of clinical condition → these children will require hospital admission for an observation period of a minimum of 6 – 8hrs post-antibiotic administrationĬhildren should be considered unwell when they have the following features:.Follow the NBR guideline as above on initial ED presentation.* Children who have received pre-hospital IM / IV Benzylpenicillin: Management of the Child with a Non-Blanching Rash: 6, 7, 15, 16 The algorithm in this guideline is based on observation & investigation of these children and acts as a guide to their initial assessment and management. Once the above differentials have been excluded, this leaves us with a further group of children in whom we need to distinguish invasive meningococcal disease and other underlying bacterial sepsis from self- limiting viral illness or a traumatic / mechanical cause. HUS: Haemolytic Uraemic Syndrome 5, 8, 9.The following groups are distinct diagnoses and often have specific signs and symptoms:.straining, coughing or vomiting manifestation of petechiae in the distribution of the superior vena cava – i.e. Mechanical (secondary to transient increases in vascular pressure e.g.If in any doubt – Treat as Meningococcal disease Ecchymoses: lesions of a similar appearance to purpura, but > 1cm in size (i.e.The highest rates of invasive infection are in children 2mm

Meningococcal disease remains the leading infectious cause of death amongst the paediatric population within both the UK and the developed world. The minority of children with invasive bacterial infections, such as meningococcal disease (MCD), must be distinguished from the majority of individuals presenting with a non-blanching rash secondary to a benign self-limiting illness ( 90% of paediatric hospital presentations with NBR do not have MCD furthermore petechiae can be found in up to 3% of well infants). 2% of all attendances) +/- fever and other systemic features of illness. It is not uncommon for children to present to the Emergency Department with a non-blanching rash (accounting for approx. Management of the Child with a Non-Blanching Rash Algorithm go straight to algorithm if patient unwell.

Platelet disorders pinpoint rash