The Challenge of an Infant with Fulminate Meningococcemia: A Multidisciplinary Approach
CARL WILSON, M.D., ITZEL SOLIS, M.D., JON HOLMES, P.T., C.P., AND DIANE ATKINS, O.T.R.
A 14-month-old white male was transferred to the intensive care unit at Texas Children's Hospital in septic shock due to fulminate meningococcemia. The patient received aggressive medical intervention including fluid replacement, intravenous antibiotics and mechanical ventilation. The patient required bilateral above the knee guillotine amputations secondary to severe ischemic injury. He underwent final closure of the skin approximately three months later. The patient's recovery was further complicated by severe pulmonary compromise requiring prolonged intubation. He has since been extubated but, due to continued poor pulmonary function, requires supplemental oxygen via a tracheostomy.
The patient's developmental milestones were reportedly appropriate for his age prior to onset of illness. However, he presently experiences visual impairment and cognitive deficits which have been attributed to the hypoxic/ischemic effects of septic shock.
A one-year-old bilateral above the knee amputee who has visual impairment, developmental delay and pulmonary function compromise is a challenge to any rehabilitation team. Discussion of this case will include preprosthetic therapy, progression of prosthetic design, gait training and therapy intervention techniques that encourage developmental growth and functional independence.
The Institute for Rehabilitation and Research, Baylor College of Medicine, 1333 Moursund, Room A-221, Houston, TX 77030