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Published on: December 4, 2013
Neuropsychological outcome after severe pediatric near-drowning
Insights
Near-drowning in children often leads to severe outcomes, with many experiencing death or vegetative states. However, early motor activity and pupillary response can indicate a chance for intact survival and recovery.
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.
Abstract:
Between April 1979 and August 1983, 49 nearly drowned children in serious condition were admitted to Childrens Hospital of Los Angeles (CHLA) with Glasgow coma scores of 3, 4, or 5 and underwent intracranial pressure monitoring and brain resuscitative therapy. Of the 49 patients, 29 (59%) died in the hospital 1 day to 3 months after admission, 13 (27%) were discharged in vegetative states, and 7 (14%) made good recoveries. No patient made a partial neurological recovery. The sustained mean highest intracranial pressure was significantly higher and the sustained lowest cerebral perfusion pressure was significantly lower for those who died than for survivors (P less than 0.05), but these data did not significantly distinguish between intact and vegetative survivors. Pupillary reactivity noted on arrival at CHLA also significantly discriminated survivors and fatalities (P less than 0.05), but not between intact and vegetative survivors. The presence of any motor activity after arrival at CHLA, even posturing or twitching, indicated a significant chance for intact survival (P less than 0.05), although such activity did not discriminate between death and vegetative survival. Extensive neuropsychological testing indicated that the apparently intact recovered patients generally showed nearly average levels of cognitive functioning, with mild residual gross motor and coordination deficits.
