Abstract
Objective: To investigate the prognostic factors of coma due to intracranial infection in children, in order to judge the prognosis of coma earlier and guide appropriate treatment. Methods: 1) Collecting the clinical data of 39 comatose children due to intracranial infection admitted into Department of Neurology in Children’s Hospital of Chongqing Medical University from July to September 2007 and 2009, and analyzing their age and sex distribution, causes of coma, and laboratory examinations retrospectively. 2) Implementing the Glasgow coma score among these children immediately after admission, and collecting the serum and cerebrospinal fluid within 24 - 48 hours, and then measuring the NSE levels. 3) Following up these children 3 months after discharge, and analyzing the relationships among prognosis and age, sex, etiology, protein content in CSF, and NSE levels in Serum and CSF. Results: 1) In the cases studied, the age range was from 9 months to 14 years, the average age was (4.25 ± 2.82) years, and 9 months - 3 years, 3 - 5 years, 5 - 11 years, and ≥11 years were accounted for 33.3%, 30.8%, 30.8%, 5.1% respectively. There were 24 males and 15 females, and the gender ratio (male-to-female) was 1.6:1. 2) The group of 39 patients consists of Japanese encephalitis (23 cases, 59%), Viral encephalitis (5 cases, 12.8%), Tuberculous meningitis (5 cases, 12.8%), Acute disseminated encephalomyelitis (5 cases, 12.8%) and Purulent meningitis (1 cases, 2.6%). 3) CSF examination in 33 cases, protein elevated in 18 cases (54.5%), content between 0.47 and 4.33 g/L. 4) The statistical analysis showed that the causes, CSF protein content, serum and cerebrospinal fluid NSE levels were correlated with the prognosis, and that the age and sex had no correlation with the prognosis. Conclusions: 1) In this group of 39 patients, the incidence of children under 5 years old was the highest, and the incidence of boys was higher than girls. 2) Infectious diseases were the most common cause of coma in children. 3) Cerebrospinal fluid protein content was correlated with the prognosis, and the prognosis was worse as the protein content was higher. 4) NSE was a specific biochemical parameter of pathological damage nerve tissue; serum NSE levels could indirectly reflect the changes in CSF.
Highlights
Coma is a severe disturbance of consciousness, which is a common pediatric clinical department critical illness, and has a high mortality, its survivors often left with varying degrees of neurological sequelae
2) The group of 39 patients consists of Japanese encephalitis (23 cases, 59%), Viral encephalitis (5 cases, 12.8%), Tuberculous meningitis (5 cases, 12.8%), Acute disseminated encephalomyelitis (5 cases, 12.8%) and Purulent meningitis (1 cases, 2.6%). 3) CSF examination in 33 cases, protein elevated in 18 cases (54.5%), content between 0.47 and 4.33 g/L. 4) The statistical analysis showed that the causes, CSF protein content, serum and cerebrospinal fluid NSE levels were correlated with the prognosis, and that the age and sex had no correlation with the prognosis
3) Cerebrospinal fluid protein content was correlated with the prognosis, and the prognosis was worse as the protein content was higher
Summary
Children coma can occur at any age, but more common in children under 5 years of age [1]. Non-traumatic coma is the most common in children; infection is the most common cause of non-traumatic coma in children, accounting for 38%. Other causes include poisoning, long-term seizures, congenital malformations of the brain or heart, hypoxic-ischemic damage, metabolic diseases (e.g. diabetic ketoacidosis), etc. Coma prognosis depends largely on the extent of damage of primary disease and reasonable treatment. Age, gender, etiology, laboratory tests of 39 cases of children with coma were analyzed retrospectively and we analyzed the relationship among age, sex, etiology, cerebrospinal fluid protein, serum and cerebrospinal fluid NSE content and prognosis. The aim was to investigate prognostic factors of children with intracranial infection coma, facilitate early prediction coma prognosis and guide appropriate treatment
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