NEW dossier — no manifest / atoms / package / design brief on disk yet (manifest field intentionally empty). NEXT STEPS: (1) author manifest at prisma/seed/manifests/id.bacterial-meningitis.peds.v1.ts; (2) write _design-brief.md; (3) RxCUI validation for ceftriaxone / cefotaxime / ampicillin / gentamicin / vancomycin / dexamethasone / acyclovir / rifampin / ciprofloxacin / cefepime / meropenem / metronidazole; (4) PMID landmark trials (Cochrane corticosteroids in bacterial meningitis, IDSA 2004 guideline papers, AAP Red Book references); (5) calculator gaps — Bacterial Meningitis Score for children (Nigrovic), CSF cell-count thresholds by age band need entries. Drug guidance grounded in IDSA 2004 + AAP Red Book + Cochrane dexamethasone (Hib hearing-loss benefit) + ESCMID 2016. Critical timing: dexamethasone must be given BEFORE OR WITH the first antibiotic dose. Antibiotics within ≤30-60 min of recognition; ≤30 min for suspected meningococcaemia. Sibling differentiation from id.bacterial-meningitis.core.v1 covers 10 features and adolescent transition handling. Deepened 2026-05-14 (shard-5-obped-id depth-pass-1): added co-located _briefs/id.bacterial-meningitis.peds.v1.depth.md (companion to existing 2026-04-27 Playbook 0.5 brief) + _research-bundles/id.bacterial-meningitis.peds.v1.md. Added outpatient post-meningitis setting playbook (peds-ID at 4-6 weeks; audiology at 4-6 weeks per Cochrane Brouwer 2010 PMID 20824838 — ~30% pneumococcal / ~10-20% Hib / ~5-10% meningococcal sensorineural hearing loss in peds survivors; neurodevelopmental assessment at 3 mo + 6 mo + annually with formal tools — Bayley III / Ages-and-Stages / Vineland; vaccination catch-up per ACIP — PCV20 if pneumococcal / Hib if not vaccinated / MenACWY + MenB if meningococcal; close-contact chemoprophylaxis reinforcement — rifampin or cipro or single-dose ceftriaxone; antiseizure med taper plan; speech therapy if developmental regression; mental-health screen — PHQ-9-A / UCLA-PTSD-RI / caregiver PHQ-9 + PSS-FH). Added 6 severity triggers: pediatric_meningitis_with_hemodynamic_instability (life_threatening; routes to id.sepsis.peds.v1 with heparinised carryover state — organism, current empiric regimen, dex status, lactate, MAP, GCS, LP/CSF source-control plan; vasoactives + early steroids per SSC peds 2020 PMID 32032273), delayed_lp_or_abx_after_clinical_suspicion_peds (severe; ≥ 1 h mortality gradient stronger in peds per Kumar 2006 + Auburtin CCM 2006 PMID 16915106 + SSC peds 2020 Hour-1 bundle analog), pediatric_raised_icp_features (life_threatening; fontanelle bulging in infant + Cushing reflex + paradoxical irritability → mannitol 0.5-1 g/kg OR 3% hypertonic saline 5 mL/kg + peds-neurosurgery; HOB 30° + neutral neck; controlled ventilation avoid hyperventilation past pCO2 < 30), pediatric_bacterial_vs_viral_score_high_risk (severe; Nigrovic BMS ≥ 1 = admit + abx + LP-confirmed per Nigrovic JAMA 2007 PMID 17200475 derivation in 3,295 children with CSF pleocytosis; BMS = 0 + reliable safety-net = consider outpatient observation), hearing_loss_screening_required (severe; admit-discharge gate — audiology before discharge or 4-6 wk per AAP Red Book + NICE NG240 2024), subdural_empyema_or_brain_abscess_features (life_threatening; focal neuro + persistent fever despite ≥ 48 h appropriate abx → urgent MRI + peds-neurosurgery for drainage; extended IV abx course 6-8 wk; consult peds-neurosurgery + peds-ID per IDSA 2004 Tunkel + IDSA/AAN 2017 PMID 28203777). Replaced 4 legacy cross-cutting trial PMIDs (DELIVER / ProMISe / POINT / REDUCE — retained for cross-reference but supplemented) with 12 meningitis-anchored PMIDs (15494903 IDSA 2004 Tunkel, 15509818 van de Beek NEJM 2004, 21612470 Thigpen NEJM 2011 epidemiology, 17200475 Nigrovic BMS JAMA 2007, 12432041 de Gans NEJM 2002 dex RCT, 20824838 Brouwer Cochrane 2010 corticosteroids — Hib hearing-loss peds anchor, 27062097 ESCMID 2016, 16915106 Auburtin CCM 2006 antibiotic-timing-mortality, 2810603 Spanos JAMA 1989 CSF/bedside LR derivation, 28203777 IDSA/AAN 2017 healthcare-associated, 32032273 SSC peds 2020 Weiss for meningitis-with-shock routing, 21163445 Dalmau Lancet Neurol 2011 anti-NMDAR encephalitis ddx (citation-remediated 2026-05-22)). Bumped evidence.last_reconciled to 2026-05-14; evidence.pmids array from 4 to 16 (12 new meningitis-anchored + 4 legacy retained). Phenotype matrix (age-band: neonatal-early < 7 d / neonatal-late 7-28 d / 1-3 mo / 3 mo - 1 y / 1-5 y / 5-12 y / 12-17 y × organism: pneumococcus / meningococcus / Hib / Listeria / GBS / E. coli / TB / viral [enterovirus / HSV / arboviral] / cryptococcal / autoimmune [anti-NMDAR] × host: immunocompetent / immunocompromised / unvaccinated / sickle-cell / CF / transplant / preterm / muscular dystrophy × complications: cerebral edema / hydrocephalus / seizure / hearing loss / vasculitis / cerebritis-abscess / persistent encephalopathy × LP-deferred status × vaccination status — ~15,680-cell collapsed cross-product) encoded indirectly via severity_triggers (meningococcaemia_features, raised_icp_or_herniation_signs, status_epilepticus_with_meningitis, septic_shock_with_meningitis, ct_indication_before_lp, unvaccinated_for_hib, recurrent_meningitis, pediatric_meningitis_with_hemodynamic_instability, delayed_lp_or_abx_after_clinical_suspicion_peds, pediatric_raised_icp_features, pediatric_bacterial_vs_viral_score_high_risk, hearing_loss_screening_required, subdural_empyema_or_brain_abscess_features) + regimen_axes.steps (neonate_under_1_month / infant_1_to_23_months / over_2_years / healthcare_associated_or_post_neurosurgical) + per-setting playbook logic (ed / inpatient / icu / outpatient). First-class TS field for phenotype matrix is schema-blocked — deferred to shard schema proposal cache. Bayesian linkage (pre-test priors per Nigrovic JAMA 2007 PMID 17200475 derivation in 3,295 children with CSF pleocytosis — bacterial meningitis ~5-10% baseline in peds ED with suspected infection, ~30-50% with BMS ≥ 1, ≤ 0.1% with BMS = 0 + alert child; neonatal HSV ~0.5-1% baseline rising to ~5-10% with vesicles or maternal genital HSV; Hib post-vaccine US baseline near-zero vs historical 1-5% unvaccinated cohort per Thigpen NEJM 2011 PMID 21612470; peds-specific LRs — bulging fontanelle + fever LR+ ~8 [verify], Kernig/Brudzinski LR+ ~4-9 in older child per Spanos PMID 2810603 tempered by Thomas CID 2002 PMID 12353223 poor real-world sensitivity, CSF WBC >1000 + bacterial pattern LR+ ~15-30 per Spanos, CSF lactate ≥ 3.5 mmol/L LR+ ~10-20 per Sakushima J Infect 2011 PMID 21238777, CSF Gram positive LR+ ~50-200, multiplex PCR FilmArray ME approaches Gram, procalcitonin ≥ 0.5 LR+ ~3-5 peds, HSV PCR positive in neonate LR+ > 100, Nigrovic BMS = 0 sensitivity ~100% NPV near-perfect, petechial rash + fever LR+ ~10-30 for meningococcaemia per NICE NG240, Cushing triad in child LR+ ~15-20 for raised ICP per Glaser NEJM 2001 PMID 11172164 analog; T_treat ≈ 10-20% post-test bacterial meningitis = start empirics + dex within 30 min if LP delayed AND any of GCS < 14 / focal deficit / petechial rash / immunocompromise / hemodynamic instability / infant with fontanelle bulging or paradoxical irritability; T_test ≈ 5% in alert child + Nigrovic BMS = 0 + viable viral aetiology + reliable safety-net = outpatient observation 24-h re-check; T_monitor PICU = shock OR seizure OR AMS OR raised ICP OR age < 1 mo with severe disease; cross-dossier routing to id.sepsis.peds.v1 for hemodynamic instability with heparinised carryover, peds.status_epilepticus.v1 for status with heparinised carryover, id.bacterial-meningitis.core.v1 for adolescent crossover at 18 yr, planned neuro autoimmune encephalitis for anti-NMDAR features per Dalmau PMID 21163445, planned TB engine for endemic / immunocompromised, id.cryptococcal-meningitis.core.v1 for CD4 < 100 + CrAg positive) documented in co-located _research-bundles/id.bacterial-meningitis.peds.v1.md. ROS/DDx LR seed data audited by npm run audit:ros-ddx-coverage (cross-cutting; not touched by this shard). Prehospital recognition (NICE NG240 — single-dose IM benzylpenicillin or IV ceftriaxone if meningococcal disease suspected and transport delay anticipated; pediatric assessment triangle; fontanelle assessment in infants; petechial rash inspection) is partially encoded via the ED-setting required_assessments + non_drug_actions; a first-class "prehospital" DossierSetting value is schema-blocked, and the transitions[] array (admit/escalation/de-escalation pattern from peds.dka.v1 template) was not authored in this pass — deferred. Nigrovic BMS not yet a first-class calculator id (calc.nigrovic_bms) — pending clinical-tools-registry addition.