ABSTRACT 11

Abstract

Background and aims: Fatality rates and neurological sequelae among survivors of childhood acute CNS infections as high as 50%. Most of it is attributable to raised intracranial pressure (ICP >20 mmHg). Aims: Comparing the long-term outcome in CPP versus ICP-targeted therapy in children with raised ICP due to acute CNS infection. Methods: Design: Prospective open label RCT in level-III PICU. Period: July-2007 to December-2010 and last follow-up completed on November-2013. Participants: Children, aged 1–12 years, with raised ICP and modified-GCS Score ≤ 8. Interventions: ICP measured with intraparenchymal microtransducer (CODMAN®). Patients were randomized to receive either CPP-targeted therapy (n=55) (CPP ≥ 60 mm Hg) or ICP-targeted therapy (n=55) (ICP < 20 mm Hg). Follow-up: Survivors (n=79) followed upto 5 years after PICU discharge. Evaluation of functional status using Pediatric Cerebral Performance Category and Pediatric Overall Performance Category Score was done by an examiner blinded to protocol assignment. Outcome measures: Functional status upto 5 years after PICU discharge.(CTRI/2012/05/002650). Results: Survivors completed the median (IQR) follow-up of 5 (4.3–5.8) years. Intact-survival at PICU discharge (CPP-group 46.7% vs. ICP-group 17.6%; RR=0.38, 95% CI 0.17–0.84, P=0.007), at 1-year (68.9% vs. 44.1%; RR=0.64, 95% CI 0.42–0.98, p=0.027), at 3-years (77.8% vs. 50%; RR=0.44, 95% CI 0.23–0.84, p=0.010) and at 5-years (80% vs. 53%; RR=0.66, 95% CI 0.47–0.94, p=0.010) was higher in CPP-group. Hearing deficit was significantly lower in CPP-group than ICP-group (8.9% vs. 38.2%; RR=0.23, 95%CI 0.08–0.65, p=0.002). Conclusions: Cerebral perfusion pressure-targeted therapy improves the long-term outcomes in children with raised ICP due to acute CNS infections.