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Polyneuropathy in Critically Ill Mechanically Ventilated Children: Experience From a Tertiary Care Hospital in North
Shantanu Shubham1, Nitin Dhochak1, Akanksha Singh2
1Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India.
Insights
Critical illness polyneuropathy is highly prevalent in children requiring prolonged mechanical ventilation, often linked to sepsis. Further research is needed to identify specific risk factors in this vulnerable pediatric population.
Area of Science:
- Pediatric critical care medicine
- Neurology
- Intensive care research
Background:
- Critical illness polyneuropathy (CIP) is a common complication in intensive care units.
- Understanding CIP prevalence and risk factors in pediatric patients is crucial for improving outcomes.
- Prolonged mechanical ventilation is a significant factor in the development of CIP.
Purpose of the Study:
- To determine the prevalence of critical illness polyneuropathy (CIP) in critically ill children.
- To identify potential risk factors associated with CIP in this pediatric population.
- To investigate the role of micronutrients in the development of CIP.
Main Methods:
- An observational cohort study was conducted in a pediatric intensive care unit (PICU).
- Nerve conduction studies and muscle strength assessments were used to diagnose CIP.
- Data on patient demographics, clinical characteristics, and laboratory values were collected.
Main Results:
- A high prevalence of critical illness polyneuropathy (90.6%) was observed in children mechanically ventilated for 7 days or more.
- Sepsis and multiple organ dysfunction were present in nearly all affected children.
- No specific risk factors for CIP were identified in this study, and micronutrient levels did not significantly differ between groups.
Conclusions:
- Critical illness polyneuropathy is highly prevalent in critically ill children requiring prolonged mechanical ventilation.
- Sepsis is a common underlying condition in children with CIP.
- Further studies with larger sample sizes are needed to identify definitive risk factors for CIP in pediatric patients.
Objectives:
To determine the prevalence of critical illness polyneuropathy and its risk factors in critically ill children mechanically ventilated for 7 days or more.
Design:
Observational cohort study.
Setting:
PICU of a tertiary care hospital from North India.
Patients:
Children 1-15 years old admitted in PICU from June 2016 to September 2017, mechanically ventilated for 7 days or more, excluding those with diagnosed neuromuscular disease, stroke, or spinal pathology.
Intervention:
Demographic details, diagnosis, treatment details, and anthropometry at admission and enrolment were recorded. Nerve conduction studies were performed after enrolment and repeated a week later, if the child was still in PICU. Medical Research Council scoring for muscle strength was performed in survivors. Risk factors including Pediatric Index of Mortality-2 score, sepsis, multiple organ dysfunction, hypoalbuminemia, use of steroids, neuromuscular-blocking agents, and vasopressors were recorded. Samples for the level of micronutrients (copper, zinc, folate, and vitamin B12) were collected at the time of enrolling the child and at the time of discharge.
Measurements And Main Results:
Thirty-two children were enrolled, of whom 29 had features of critical illness polyneuropathy on evaluation at day 8 of mechanical ventilation (prevalence, 90.6% [95% CI, 80.5-100%]). The polyneuropathy was axonal in 26 (81.2%), mixed in one patient (3.1%), and uncharacterized in two (6.2%). Sepsis and multiple organ dysfunction were present in 31 subjects (96.9%). No risk factors for critical illness polyneuropathy could be identified although the study was not sufficiently powered to do so. The difference between serum micronutrient levels (copper, zinc, folate, and vitamin B12) between patients who developed polyneuropathy, and those who did not, was statistically insignificant.
Conclusions:
We observed a high prevalence of critical illness polyneuropathy in children in PICU, mechanically ventilated for 7 days or more; almost all of whom had underlying sepsis.
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