Neurologic manifestation of Covid-19 pediatric patients admitted at the Philippine Children's Medical Center in the year 2020: a case series

@#<p>Covid-19 which was first documented in the Philippines in January 2020 had spread alarmingly. Severe acute respiratory symptoms were the most common presentation of this novel coronavirus infection. Reports have described neurologic manifestations of this disease involving the central nervous system as well as the peripheral nervous system. However, studies among the pediatric population are limited. In this paper, we present three pediatric patients who were diagnosed with COVID-19, via RT-PCR, presenting with seizures and behavioral changes. Two of these patients have no concomitant respiratory symptoms while the other one had Pediatric Community Acquired Pneumonia. These patients were managed as cases of acute viral meningoencephalitis and were given supportive care.</p>

Efficacy of 20% Mannitol versus 3% hypertonic saline in decreasing intracranial pressure in the pediatric age group: A systematic review

@#<p><strong>Background:</strong> There are no established guidelines preferring mannitol over hypertonic saline in managing increased intracranial pressure in children.</p><p><strong>Objective:</strong> This systematic review aimed to assess the available data on the efficacy of 20% mannitol and 3% hypertonic saline in decreasing intracranial hypertension in the pediatric age group.</p><p><strong>Method:</strong> Search was done through PubMed/MEDLINE, Cochrane Central Registry of Clinical Trials (CENTRAL) and EMBASE. The search of articles yielded 280 studies. After applying the inclusion and exclusion criteria, a total of 7 articles were deemed eligible for assessment.</p><p><strong>Results:</strong> Seven studies with a total of 1,892 pediatric patients met the eligibility criteria: three RCTs and four retrospective studies. From these studies, two randomized controlled studies showed statistically significant evidence that 3% hypertonic saline was superior to 20% mannitol in reducing increased intracranial pressure (ICP) while two other studies had results that were insufficient to establish statistical significance. A study showed that Glasgow coma scale (GCS) scores were higher and length of stay was shorter in patients given hypertonic saline than in the mannitol group. Relative risk of mortality was comparable in both groups. While more episodes of hypotension and rebound increase in ICP was seen with mannitol, both agents reported occurrences of acute kidney injury, hemolysis and hyperchloremic metabolic acidosis.</p><p><strong>Conclusion:</strong> This review showed that while both agents effectively decreased intracranial pressure, 3% hypertonic saline showed better results compared with 20% mannitol. Due to the limited number and heterogeneity of studies, a pooled analysis of the effects in ICP could not be done. Recommendations: Larger prospective controlled studies using 20% mannitol and 3% hypertonic saline in the treatment of increased ICP in the pediatric age group are needed to render valid affirmations.</p>