Acute Symptomatic Seizures in Critically Ill Children: Frequency, Etiology and Outcomes
Sanam B Rajper1, Mujtaba Moazzam2, Arsheen Zeeshan1
1Department of Pediatrics and Child Health, Aga Khan University Karachi, Karachi, Pakistan.
Insights
Infections commonly cause new-onset seizures in critically ill children. Seizures exceeding 10 minutes correlate with neurological deficits but not mortality.
Area of Science:
- Pediatric Critical Care Medicine
- Pediatric Neurology
- Clinical Pediatrics
Background:
- Critically ill children face a heightened risk of acute symptomatic seizures due to systemic illnesses.
- Untreated seizures in this population can rapidly progress to status epilepticus, a condition linked to significant morbidity and mortality.
Purpose of the Study:
- To investigate the frequency, causes, and outcomes of seizures in critically ill children admitted to a tertiary care hospital's intensive care unit.
- To identify common etiologies and associated factors for new-onset seizures in pediatric intensive care unit (PICU) patients.
Main Methods:
- A retrospective review of medical records for children admitted to the pediatric intensive care unit (PICU) between January 2016 and December 2018.
- Data collection included demographic, clinical, and outcome information for new-onset seizures, followed by univariate analysis.
Main Results:
- Out of 2053 PICU admissions, 106 (5%) experienced seizures. Common primary diagnoses included meningitis (20%), sepsis (20%), and complicated pneumonia (17%).
- Seizures lasting over 10 minutes occurred in 10% of cases and were significantly associated with neurological deficits (P = 0.001).
- No correlation was found between seizure duration or type and electrolyte imbalance, renal failure, or need for ventilator support (P > 0.005).
Conclusions:
- Infections are the leading cause of new-onset seizures in children admitted to the PICU.
- Prolonged seizures (>10 minutes) in critically ill children are linked to a higher incidence of neurological deficits.
- Seizure duration did not show an association with mortality in this cohort.
Background:
Critically ill individuals have an increased risk of acute symptomatic seizures secondary to systemic illnesses; unrecognized or untreated seizures can quickly convert into status epilepticus, which is associated with high morbidity and mortality.
Objective:
The aim of this study was to determine frequency, etiology, and outcome of seizures in critical ill children admitted in intensive care unit of a tertiary care hospital.
Materials And Methods:
Retrospective review of medical records of all children admitted in pediatric intensive care unit (PICU) of the Aga Khan University from January 2016 to December 2018 and who had a new-onset seizure irrespective of underlying diagnosis was carried out after ethical review committee approval. Data were collected on a structured proforma; it included demographic information as well as relevant clinical and outcome information. The data were analyzed on Statistical Package for the Social Sciences (SPSS) software program, version 19.0. The descriptive statistics frequency and percentage was computed for qualitative variable. Mean and standard deviation were computed for quantitative variable, and univariate analysis was performed.
Results:
During the study period, a total 2053 patients were admitted in the PICU. One hundred six (5%) had seizure. Sixty-three (59.5%) were males. Meningitis 21 (20%), sepsis 21 (20%), complicated pneumonia 18 (17%) were the major primary diagnosis in these children. Mean age of the study population was 75 months (standard deviation [SD] ± 54.4) and 72 (68%) were <5 years of age, whereas 63 (59.5%) were males. The seizures lasted >10min in 10 (10%) and were associated with high had neurological deficit (P = 0.001). We did not observe any correlation with electrolyte imbalance, renal failure, need of ventilator support with duration of seizure, and type of seizure (P > 0.005).
Conclusion:
Infection was the most common etiology associated with a new-onset seizure in children admitted in our PICU. Seizures lasting for >10min were observed with high neurological deficit. We did not find any association of mortality with seizure duration.
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