Coma in Childhood

Abstract

Publisher Summary Coma is an important and common clinical problem in pediatric practice. The comatose state in children results from trauma or a wide variety of nontraumatic causes. It is clinically useful to classify causes into (1) those generally associated with structural changes in the brain and (2) those with predominant metabolic dysfunction. The metabolic causes of coma can be associated with structural changes in the brain. The assessment and management of a child in coma requires a multidisciplinary coordinated team approach with each member of the team being assigned a specific responsibility especially when coma is complicated by poor cardiorespiratory function, shock, or status epilepticus, and all of them must be rapidly addressed. Investigations have to be tailored to the individual case and the clinician's diagnostic considerations. Tests for infection (sepsis, meningitis, and encephalitis) include toxicology screen, neuroimaging, conventional electroencephalogram (EEG), continuous EEG monitoring, and serum biomarkers. Those who have suffered a metabolic or toxic encephalopathy have a good outcome provided the secondary effects of the cause are minimized and systemic complications avoided. Several advances have improved our understanding and management of coma in children. These include recognition of a number of inborn errors of metabolism, progress in the prevention, diagnosis, and treatment of infective diseases, prevention of head trauma, magnetic resonance imaging (MRI), and an emerging consensus on the management of raised intracranial pressure (ICP).