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Published on: November 20, 2015
Outcome of Encephalitis in Pediatric Intensive Care Unit
Kam-Lun Ellis Hon1, Yin Ching K Tsang2, Lawrence C N Chan2
1Department of Pediatrics, The Chinese University of Hong Kong, Prince of Wales Hospital, 6/F, Clinical Sciences Building, Shatin, Hong Kong. ehon@hotmail.com.
Insights
Viral encephalitis in pediatric intensive care units (PICUs) leads to high mortality and severe neurodevelopmental impairments in survivors. Early identification of pathogens and risk factors is crucial for improving outcomes in these critically ill children.
Area of Science:
- Pediatric critical care medicine
- Infectious diseases
- Neuroscience
Background:
- Encephalitis is a serious condition affecting the brain, particularly in children.
- Identifying causative pathogens and understanding outcomes in pediatric intensive care units (PICUs) is essential for effective management.
Purpose of the Study:
- To review the pathogens, morbidity, and mortality associated with viral and infectious encephalitis in pediatric intensive care unit (PICU) patients.
- To analyze risk factors and outcomes, including neurodevelopmental impairments, in pediatric encephalitis cases.
Main Methods:
- A retrospective chart review was conducted for all patients diagnosed with encephalitis and admitted to the PICU between 2002 and 2014.
- Data collected included identified pathogens, clinical course, treatments received, and patient outcomes.
Main Results:
- Encephalitis represented 2.7% of PICU admissions but contributed to 11.8% of PICU mortality.
- Viruses were identified in 59% of cases, with enteroviruses and herpes viruses found in cerebrospinal fluid (CSF).
- Over 25% of patients died, and 55% of survivors experienced moderate-to-severe neurodevelopmental impairments. Male gender and corticosteroid use were associated with poorer survival.
Conclusions:
- Encephalitis carries a significant mortality rate and leads to substantial long-term neurodevelopmental deficits in pediatric patients, even with intensive care.
- Corticosteroid treatment may be associated with reduced survival chances in pediatric encephalitis patients.
- No emerging outbreaks of encephalitis were observed during the study period.
Objective:
To review pathogens, morbidity and mortality in pediatric intensive care unit (PICU) patients with viral and infectious encephalitis.
Methods:
Retrospective chart review of all patients with encephalitis admitted to the PICU between 2002 and 2014 was done.
Results:
Encephalitis (n = 46) accounted for 2.7 % of PICU admissions, but 11.8 % PICU mortality over a 12-y period. A microorganism (primarily virus) was identified in 59 % of encephalitis patients in the PICU. Enteroviruses and herpes viruses were isolated from the cerebrospinal fluid (CSF). Respiratory viruses [such as respiratory syncytial virus (RSV) and influenza viruses] and enteric viruses (such as rotavirus and norovirus) were obtained in the nasopharyngeal aspirate and stool respectively, but undetectable from the CSF. More than one-fourth patients with encephalitis died in the PICU. Boys accounted for 85 % of nonsurvivors and 52 % survivors (p = 0.038). Mechanical ventilation, inotrope, intravenous immunoglobulin (IVIG) and corticosteroid usage were significantly higher among non-survivors (p 0.001-0.044). Binomial logistic regression showed that patients who received corticosteroid had a lower chance of survival than those who did not after adjusting for gender, IVIG and mechanical ventilation (adjusted odd ratio = 0.071, 95 % CI 0.006-0.881; p 0.039). Eighteen (55 %) of the survivors had moderate-to-severe neurodevelopmental impairments.
Conclusions:
Encephalitis is associated with significant mortality despite intensive care. Over 25 % case died and 55 % of survivors had moderate-to-severe neurodevelopmental impairments. There appeared to be no emerging outbreaks of encephalitis during the 15-y study period.
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