Neurocognitive long term follow-up study on drowned children
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Pertti K Suominen1, Niina Sutinen2, Saija Valle1
1Children's Hospital, Helsinki University Central Hospital, Finland.
Insights
Drowned children who received CPR often experience long-term neurological issues. Early CPR and prompt medical care are crucial for improving cognitive and neurological outcomes in pediatric drowning survivors.
Area of Science:
- Pediatric neurology
- Emergency medicine
- Neuropsychology
Background:
- Drowning is a leading cause of accidental death in children.
- Successful cardiopulmonary resuscitation (CPR) in pediatric drowning cases can lead to survival, but long-term outcomes are not fully understood.
Purpose of the Study:
- To evaluate the long-term cognitive and neurological outcomes in children who survived drowning incidents after receiving CPR.
- To compare outcomes based on whether CPR was administered by bystanders or emergency medical services (EMS).
Main Methods:
- A cohort of 21 pediatric drowning survivors who received CPR between 1985 and 2007 underwent neurological and neuropsychological examinations.
- Data included age at drowning, age at examination, interval between events, and neurological status.
- Statistical analysis used Mann-Whitney U, Wilcoxon signed ranks, and Chi-square tests.
Main Results:
- 57.1% of survivors exhibited minor or major neurological dysfunction.
- 40% had a low full-scale intelligence quotient (FIQ < 80).
- Longer submersion times correlated with lower FIQ scores (p=0.0013).
Conclusions:
- A significant proportion of pediatric drowning survivors experience long-term neurological and cognitive deficits.
- Long-term neurological and neuropsychological follow-up is essential for these children.
- While some children may appear to recover fully at hospital discharge, underlying deficits can persist.
Aim Of The Study:
Report cognitive and neurological outcome later in life of surviving drowned children who had received CPR either from bystanders or from emergency medical services (EMS) units.
Methods:
Forty children who had drowned and admitted to pediatric intensive care unit after successful CPR between 1985 and 2007, were eligible for the study. Of those 21 gave a consent for neurological and neuropsychological examinations. All data are expressed as median (interquartile range). Mann-Whitley U, Wilcoxon signed ranks and Chi square tests were used.
Results:
The median age of the 21 patients at drowning was 2.4 (1.8, 5.5) years and 12.5 (8.6, 19.4) years at the time of neurological and neuropsychological examination. The median interval between the drowning accident and examinations was 8.1 (5.4, 14.4) years. Twelve patients (57.1%) had either signs of minor (6/21) or major neurological dysfunction (6/21). Eight subjects (40.0%) had full-scale intelligence quotient (FIQ) of less than 80 (range 20-78). The median estimated submersion time of the subjects with normal FIQ was 3.5 (2.0, 7.5)min, which was significantly shorter than for those with FIQ<80, 12.5 (5.0, 22.5)min (p=0.0013). Cognitive or neurologic deficits were detected in 17 of the 21 subjects, although 11 of them were reported to have a full recovery at the hospital discharge.
Conclusions:
This study showed that 57% of the drowned and resuscitated children had neurological dysfunction and 40% a low FIQ. Neurological and neuropsychological long term follow-up in drowned children is highly recommended.
