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Outcome of severe anoxic/ischemic brain injury in children
R L Kriel1, L E Krach, M G Luxenberg
1Department of Neurology, Gillette Children's Hospital, St. Paul, Minnesota.
Insights
Children with anoxic or ischemic brain injuries often have poor outcomes, with near-drowning causing the worst results. Shorter unconsciousness periods correlate with better cognitive and motor recovery in pediatric brain injury survivors.
Area of Science:
- Pediatric Neurology
- Neuroscience
- Critical Care Medicine
Background:
- Anoxic or ischemic brain injuries significantly impact child development.
- Understanding long-term outcomes is crucial for affected children and families.
- Causes of brain injury in children vary, including near-drowning and suffocation.
Purpose of the Study:
- To report the long-term outcomes of 25 children with anoxic or ischemic brain injuries.
- To correlate injury severity and cause with neurological and developmental outcomes.
- To identify factors influencing recovery in pediatric brain injury survivors.
Main Methods:
- Retrospective case series of 25 children with brain injuries.
- Follow-up duration ranged from 1 to 14 years post-injury.
- Data collected on injury cause, duration of unconsciousness, and neurological status.
Main Results:
- Outcomes varied widely, with 11 children remaining in vegetative states (5 died).
- Seven children regained some language skills, while seven were profoundly impaired.
- Shorter unconsciousness (<60 days) correlated with better language and motor skills.
- Near-drowning was associated with worse mortality, cognitive, and feeding outcomes.
Conclusions:
- Pediatric anoxic/ischemic brain injury has a variable prognosis.
- Duration of unconsciousness and cause of injury are critical prognostic factors.
- Early identification and intervention may improve outcomes for children with brain injuries.
Abstract:
The outcome of 25 children who had anoxic or ischemic brain injuries at 2 months to 14 years of age is reported. Follow-up was from 1 to 14 years after injury; causes were near-drowning, 11; suffocation, 7; cardiac arrest, 3; electrocution with cardiac arrest, 2; strangulation, 1; aborted sudden infant death syndrome, 1. All patients were unconscious for at least 24 hours. Of 11 remaining in vegetative states, 5 died. Seven children regained some language skills and are in special education or self-contained classrooms. Seven are profoundly impaired and show only a social smile. Cognitive and motor outcomes were correlated with the severity of injury as indicated by the duration of unconsciousness. All children who regained language skills or the ability to walk were unconscious less than 60 days. Dystonic rigidity was observed in all children who were nonambulatory. Outcome was also correlated with the cause of injury; mortality, cognitive outcome, feeding outcome, and duration of unconsciousness were all worse in children with near-drowning.