[Asphyxia by immersion]

Nineteen childhood near drowning cases admitted to a private general hospital from December 31, 1983 through out December 1987 at a mean age of 2 years 3 months are discussed. All patients had diagnosis when first found by relatives, 16 were apneic and only 11 received some kind of resuscitation which complied with accepted standards in 4 of them. Seven cases were admitted in stage A of Conn, two in stage B and ten in stage C. In six children in stage C intracranial pressure (ICP) monitoring was done and ICP was increased in two that died. Five patients developed clinical and radiological evidence of non cardiogenic pulmonary edema and 4 had hypotension sometime along the first 24 hours, requiring fluid therapy and inotropic drugs. Four patients died, all of them were in stage C when admitted. One child shows severe brain damage four years after discharge. The main complications after resuscitation were hemodynamic instability, pulmonary problems and hypoxic encephalopathy. High ICP was not important in the first hours and when it rose it did so 24 to 48 hours after admission. The need for an active role in prevention, improved resuscitation and transport, is stressed.