Outcomes and Predictors of Mortality among Young Children with Acute Meningoencephalitis: A Prospective Observational Study

Introduction: Acute Meningoencephalitis (AME) is a lifethreatening condition in young children, particularly in lowresource settings, with overlapping features of meningitis and encephalitis. Despite advances in diagnostics and vaccination, evolving pathogens like dengue virus and Orientia tsutsugamushi contribute to high morbidity and mortality due to delayed diagnosis and treatment. Aim: To assess short-term outcomes, and predictors of mortality of AME in children under five years of age. Materials and Methods: The present prospective observational study was conducted at King George’s Medical University, Lucknow,Uttar Pradesh, India, from January 2020 to September 2021. Total 101 children aged between 1 month to 5 years with AME were enrolled in this study after taking a written informed consent from their parents. Detailed clinical history (fever, seizures and its type, altered sensorium, headache, diarrhoea, vomiting, bleeding, swelling, rash) and demographic details were recorded. Outcomes were classified as complete recovery, recovery with neurological sequelae, or mortality. Statistical analysis was performed using Statistical Package for Social Sciences (SPSS) version 23 for Windows. Logistic regression analysis was performed to identify independent predictors of mortality. Results: Total 101 children were enrolled with AME, with a mean age of 37.92±18.32 months, with 66 (65.3%) of the cases being male and a male-to-female ratio of 1.9:1. Out of 101 cases 69 (68.3%) were successfully treated and discharged. Among the 69 children who were discharged, 39 ( 56.5%) cases were fully conscious and recovered completely. However, 30 (43.5%) cases had some degree of altered sensorium at discharge. Of these, three children (4.3%) required nasogastric (RT) feeding, and two children (2.8%) were discharged with both tracheostomy and RT feeds in place. Persistent neurological sequelae were noted in several cases: seizures in five children (7.2%), visual and hearing impairments in five children (2.8%) each, and focal neurological deficits in two children (2.8%). The overall mortality rate was 9.9%, with factors such as immunisation status, Glasgow Coma Scale (GCS) score, renal dysfunction, and the need for mechanical ventilation associated with worse outcomes. Conclusion: According to the results of the present study key predictors of mortality in children with AME included severe GCS scores, renal dysfunction, and the need for mechanical ventilation. Early diagnosis, immunisation, and prompt treatment are crucial for improving outcomes.