Pediatrik non-travmatik koma prognozunu öngörmede klinik, elektroensefalografik ve nöroradyolojik parametrelerin rolü

Abstract

To investigate the early outcome of non-traumatic coma (NTC) in pediatric critical care in relation to the prognostic role of clinical, electroencephalographic, and neuro-radiological factors. Materials and methods: A total of 77 children (means of age: 70.5±68.7 months, 55.8% were boys) with acute encephalopathy, and NTC were included in this retrospective cross-sectional study. Data on patient demographics (age, gender, etiology of NTC) and prognostic factors [Glasgow coma scores (GCS), pupillary light reflex (PLR), electroencephalography (EEG) and cranial magnetic resonance imaging (MRI) findings] and neurological outcome (intensive care unit period and first 3 months after discharge) were recorded in each patient. Results: Hypoxic-ischemic encephalopathy (35.1%) and central nervous system infection (22.1%) were the most common etiologies in this study. The favorable and unfavorable neurological outcome was noted in 57% and 43% of patients, respectively. Lack of PLR (OR 3.09, 95% CI: 2.17 to 4.40, p<0.001), GCS ≤5 (OR 7.85, 95% CI: 2.77 to 22.37, p<0.001), poor prognostic pattern in EEG (OR 13.76, 95% CI: 1.62 to 116.54, p=0.004) and presence of MRI lesions (OR 4.04, 95% CI: 1.15 to 14.19, p=0.029) were significant determinants of unfavorable neurological outcome. Conclusion: We conclude that combined use of clinical, EEG, and MRI findings might provide a more accurate estimation of neurological outcome in pediatric NTC.

Clinico-Etiological Profile and Predictors of Mortality of Nontraumatic Coma in Children of Upper Egypt: A Prospective Observational Study

“…These etiologies are slightly different than those found in Turkey where hypoxic ischemic encephalopathy was as common as CNS infections. [19][20][21][22] In accordance with Gwer et al, 23 our study showed that viral encephalitis was the most common CNS infection. This differs from other studies that revealed a higher frequency of acute bacterial meningitis.…”

Nontraumatic coma in the pediatric intensive care unit: etiology, clinical characteristics and outcome

“…We concluded that, only the presence of abnormal pupillary light reflex was associated with mortality; however, this relationship was insignificant when assessed as an independent risk factor. Previous studies have reported that the absence of pupillary light reflex is associated with unfavorable neurological outcome and mortality [22]. In the present study, the absence of pupillary light reflex and unequal pupillary light reflex findings were evaluated together, which may have caused variations in results.…”

“…Among the children with NTC, neuroinfectious etiology was the most common cause of encephalopathy with viral encephalitis being the most frequent diagnosis. A study from Turkey found that hypoxic ischemic encephalopathy (HIE) and neuroinfection were the most common causes of NTC [22]. Similarly, studies from other countries like Pakistan, India, United Kingdom, Nigeria, Malaysia and Saudi Arabia also reported neuroinfection as a leading cause of NTC [4,13,19,[23][24][25].…”