Neuropsychological outcome after severe pediatric near-drowning

Area of Science:

• Pediatric Critical Care Medicine
• Neuroscience
• Emergency Medicine

Background:

• Near-drowning incidents in children are a significant cause of pediatric morbidity and mortality.
• Severe hypoxic-ischemic brain injury is a common consequence of near-drowning, necessitating intensive care.

Purpose of the Study:

• To evaluate the neurological outcomes and survival rates of children admitted to the Childrens Hospital of Los Angeles (CHLA) following near-drowning.
• To identify prognostic indicators for survival and neurological recovery in pediatric near-drowning cases.

Main Methods:

• Retrospective analysis of 49 pediatric patients with severe near-drowning (Glasgow Coma Scale 3-5) admitted between 1979 and 1983.
• Intracranial pressure monitoring and brain resuscitative therapy were employed.
• Neurological assessments, including pupillary reactivity, motor activity, and neuropsychological testing, were conducted.

Main Results:

• 59% of patients died, 27% were discharged in vegetative states, and 14% achieved good recoveries.
• Higher intracranial pressure and lower cerebral perfusion pressure were associated with mortality.
• Pupillary reactivity and the presence of any motor activity (even posturing) were significant predictors of survival.

Conclusions:

• Pediatric near-drowning carries a high risk of mortality or severe disability.
• Early neurological signs, such as motor activity and pupillary response, are crucial prognostic indicators.
• Intact survivors demonstrated near-average cognitive function with mild motor deficits.