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Neuromuscular complications of sepsis in children
1Department of Neurology, West Virginia University Health Sciences Center, Morgantown 26506-9180, USA.
Insights
Sepsis in pediatric intensive care units can cause significant neuromuscular dysfunction, affecting multiple organ systems. Early identification and evaluation are crucial for managing weakness and improving patient outcomes.
Area of Science:
- Pediatric critical care medicine
- Neurology
- Intensive care medicine
Background:
- Sepsis is a common and serious condition in pediatric intensive care units (PICUs), leading to significant morbidity and mortality.
- While peripheral nervous system dysfunction is well-documented in adults with sepsis, its incidence and presentation in children are less defined.
- Neuromuscular complications, including weakness and difficulties with ventilator weaning, are increasingly recognized in pediatric sepsis cases.
Purpose of the Study:
- To define the incidence and characteristics of neuromuscular dysfunction in children with sepsis.
- To identify specific neuromuscular syndromes associated with sepsis in pediatric patients.
- To understand the pathogenic mechanisms and recovery patterns of sepsis-induced neuromuscular disorders in children.
Main Methods:
- Review of electrophysiologic studies in pediatric patients with sepsis.
- Clinical evaluation of neuromuscular function, including assessment of muscle strength and ventilator weaning.
- Identification and classification of specific neuromuscular syndromes based on clinical and electrophysiologic findings.
Main Results:
- Sepsis frequently affects the peripheral nervous system in children, though the exact incidence requires further definition.
- Common presentations include flaccid quadriplegia and inability to wean from mechanical ventilation.
- Electrophysiologic studies reveal axonal polyneuropathies, neuromuscular junction transmission abnormalities, and acute myopathies.
- Identified syndromes include critical illness polyneuropathy, pure motor polyneuropathy, thick-filament myopathy, and necrotizing myopathy.
- Sepsis appears to be the primary pathogenic process, potentially exacerbated by steroids and neuromuscular blocking agents.
Conclusions:
- Neuromuscular dysfunction is a significant complication of sepsis in pediatric intensive care settings.
- Specific electrophysiologic and clinical syndromes can be identified in children with sepsis-induced neuromuscular weakness.
- Recovery of muscle strength typically occurs over weeks to months, highlighting the importance of supportive care and rehabilitation.
Abstract:
Sepsis occurs frequently in the pediatric intensive care unit and is a significant cause of morbidity and mortality. Multiple organ systems are adversely affected by sepsis. Approximately 70% of adult patients with sepsis have peripheral nervous system dysfunction on electrophysiologic studies, of whom 30% are symptomatic. Neuromuscular dysfunction in children with sepsis is increasingly reported; however, the incidence remains undefined. Flaccid quadriplegia with the inability to wean from ventilatory support despite full cardiopulmonary recovery is the typical presentation. However, lesser degrees of weakness may be demonstrated with careful evaluation. Electrophysiologic studies often demonstrate the presence of axonal polyneuropathies, abnormalities of neuromuscular transmission, or acute myopathies. Identifiable neuromuscular syndromes in children with sepsis include critical illness polyneuropathy, pure motor polyneuropathy, thick-filament myopathy, and necrotizing myopathy. The common underlying pathogenic process in these syndromes appears to be sepsis, which may be accentuated by the administration of steroids or neuromuscular blocking agents. Recovery in strength usually occurs over a period of weeks to months.