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The prognosis of near-drowned children
Insights
Near-drowning prognosis in children depends on immersion time and initial pH. While longer immersion and low pH indicate a poor outcome, some children with longer immersion times still had favorable prognoses.
Area of Science:
- Pediatrics
- Neurology
- Emergency Medicine
Background:
- Near-drowning incidents pose significant risks to children's health.
- Accurate prognosis is crucial for managing pediatric near-drowning cases.
Purpose of the Study:
- To identify factors influencing prognosis in children treated for near-drowning.
- To correlate clinical and physiological parameters with long-term outcomes.
Main Methods:
- Retrospective analysis of 30 pediatric near-drowning cases treated between 1971-1976.
- Categorization of patients into favorable, less favorable, and poor prognosis groups.
- Neurological, neurophysiological (EEG), and psychological assessments of survivors.
Main Results:
- Immersion time and initial pH < 7.00 were key indicators of poor prognosis.
- Low rectal temperature on admission and EEG disturbances correlated with adverse outcomes.
- Follow-up EEG recordings were more predictive of prognosis than initial recordings.
Conclusions:
- Prognostic factors in pediatric near-drowning include immersion duration, initial pH, and rectal temperature.
- EEG monitoring, particularly follow-up assessments, provides valuable prognostic information.
- Early identification of prognostic indicators aids in clinical management and outcome prediction.
Abstract:
Thirty children were treated for near-drowning in the Children's Hospital, University of Helsinki during 1971--1976. The patients were divided into 3 groups according to the prognosis: group I included 13 children (43%) with a favourable prognosis, group II four children (13%) with a less favourable prognosis who developed severe sequelae, and group III 13 children with poor prognosis and in whom the subsequent outcome proved fatal. The surviving children underwent neurological, neurophysiological and psychological examination 6--58 months after the accident. The children in group I had slight neurological or psychological signs, some children presented a lowered intellectual functioning level. The children in group II were tetraplegic, unable to speak and had convulsions. The following factors were important in affecting prognosis: the longer the immersion time, the worse the prognosis. However, prognosis could still be favourable with an immersion-time of 11-20 min. Prognosis was bad if the first pH value was less than 7.00. The arterial oxygen pressure values measured during the treatment did not correlate with the prognosis but a low rectal temperature on admission was usually associated with a bad prognosis. The degree of EEG-disturbance had a prognostic value. However, the follow-up recording correlated better with the prognosis than the recordings during the first 24 hours, after which worsening of the EEG sometimes showed a progressive brain lesion.