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The role for osmotic agents in children with acute encephalopathies: a systematic review

Samson Gwer1, Hellen Gatakaa, Leah Mwai

  • 1Centre for Geographic Medicine Research (Coast), KEMRI-Wellcome Trust Collaborative Research Programme, Kilifi, Kenya. sgwer@kilifi.kemri-wellcome.org

BMC Pediatrics
|April 20, 2010
PubMed

Insights

Hypertonic saline effectively reduces intracranial pressure in children with acute encephalopathy, outperforming mannitol. Oral glycerol also shows promise in improving outcomes for bacterial meningitis cases.

Area of Science:

  • Pediatric Neurology
  • Critical Care Medicine
  • Pharmacology

Background:

  • Raised intracranial pressure (ICP) is a critical complication in acute encephalopathies, impacting cerebral perfusion and potentially leading to fatal outcomes.
  • Current guidelines for managing ICP in children often rely on adult data, highlighting a need for pediatric-specific evidence.
  • Osmotic agents are a cornerstone of ICP management, but their efficacy and safety in pediatric populations require thorough evaluation.

Purpose of the Study:

  • To review the existing evidence on the effectiveness of osmotic agents in reducing ICP in children with acute encephalopathy.
  • To assess the impact of osmotic agents on coma resolution, neurological sequelae, and mortality in pediatric patients.
  • To compare the efficacy of different osmotic agents, including hypertonic saline and glycerol, in the pediatric population.

Main Methods:

  • A comprehensive literature search was conducted across multiple databases for studies published between January 1966 and March 2009.
  • Included studies focused on children aged 0-16 years with acute encephalopathies treated with osmotic agents.
  • Outcomes assessed included reduction in ICP, time to coma resolution, neurological sequelae, and mortality.

Main Results:

  • Hypertonic saline (HS) demonstrated superior and more sustained reduction in ICP compared to mannitol and other fluids, especially when administered via continuous infusion.
  • Bolus administration of glycerol and mannitol provided transient ICP reduction.
  • Oral glycerol was linked to reduced mortality and neurological sequelae in children with acute bacterial meningitis, while HS showed lower mortality than mannitol in non-traumatic encephalopathies.

Conclusions:

  • Hypertonic saline appears to be more effective in reducing ICP in children than other osmotic agents.
  • Oral glycerol may improve outcomes in pediatric acute bacterial meningitis.
  • Further research is needed to optimize the administration of osmotic agents for sustained ICP reduction in children.
Abstract

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