Etiology and outcome of non-traumatic coma in children admitted to pediatric intensive care unit

Non-traumatic coma is a relatively common condition in children that may cause considerable mortality and morbidity. The purpose of this study was to determine clinical presentation, etiology and outcome of non-traumatic coma in children. In a retrospective cross sectional study over a period of 5 years, files of 150 children aged between 1 month and 14 years admitted with non-traumatic coma to pediatric intensive care unit of Rasool Akram hospital were reviewed. Historical, presenting symptoms, clinical and laboratory data were collected. Etiology of coma was determined on the basis of clinical history and relevant investigations. The outcome was recorded as died or neurological condition at discharge as normal, mild or sever disability. Chi-square test was used to test the differences in categorical variables. There were 63 [42%] boys and 87 [58%] girls. The mean +/- SD age of patients was 2.7 +/- 2.35 years. Systemic presentations including nausea, vomiting, fever, lethargy and poor I feeding were more prominent in children under 2 years. Etiology of coma in 49 patients [32.7%] was infectious [meningitis, encephalitis, respiratory and systemic]. Other causes were status epilepticus 44 [29.4%], metabolic [diabetic ketoacidosis, inborn errors of metabolism] 11 [7.3%], intoxications 10 [6.7%], accidental [drowning, electrical shock, suffocation] 9 [6%], shunt dysfunction [secondary to congenital brain malformations] 7 [4.6%], others [acute disseminated encephalomyelitis, vasculitis, hypertensive encephalopathy] 11 [7.3%], unknown 9 [6%]. Infection occurred significantly [P=0.002] in children under 2 years of age, whereas accidents and intoxications were more prominent [P=0.004] in those between 2 and 6 years. Overall 25 children [16.6%] died. Of those survived 16 became severely disabled. Accidents and infections had higher mortality compared to other groups [P<0.001 and P=0.02 respectively]. Our results showed that infection was the most common cause of non-traumatic coma in childhood. Accidents and infection had higher mortality than other causes

Risk factors for intraventricular hemorrhage in very low birth weight infants

The purpose of this study was to determine the risk factors which predispose to the development of high grade IVH [grade 3 and 4] in very low birth weight infants. In a retrospective case control clinical study files of all premature infants with birth weights less than 1500 grams admitted between April 2004 and Oct 2005 to the neonatal intensive care unit of Akbar Abadi hospital in Tehran were reviewed. 39 infants with IVH grade 3 and 4 were identified. A control group of 82 VLBW infants matched for gestational age and birth weight were selected. Prenatal data, delivery characteristics, neonatal course data and reports of cranial ultrasonography were carefully collected for both groups. Those variables that achieved significance [p<0.05] in univariate analysis entered to multivariate logistic regression analysis. A total of 325 VLBW infants were evaluated. Mortality rate was 21.5%. Of the remaining the incidence of high grade IVH was 15.5%. Multivariate logistic analysis showed that following factors are associated with greater risk of high grade IVH occurrence: Low gestational age [OR: 3.72; 95% CI: 1.65-8.38], low birth weight [OR: 3.42; 95% CI: 1.65-8.38], low Apgar score at 5 minute [OR:1.58; 95% CI:1.59-6.32], hyaline membrane disease [HMD, OR: 3.16; 95% CI: 1.42-7.45] and maternal tocolytic therapy with magnesium sulfate [OR: 4.40; 95% CI: 1.10-24.5]. Our results showed that maternal tocolytic therapy, mechanical ventilation, low gestational age, low birth weight, apnea, and low 5 minute Apgar score increased the risk of major IVH