P0029 / #1808: CLINICAL CHARACTERISTICS AND OUTCOMES OF ACUTE CHILDHOOD ENCEPHALOPATHY IN A TERTIARY PAEDIATRIC INTENSIVE CARE UNIT (PICU)

Abstract

Aims & Objectives: Childhood encephalopathy comprises a wide range of etiologies. We reviewed the pattern and outcomes of children with encephalopathy admitted to the PICU of a newly established tertiary children’s hospital Methods: We retrospective reviewed the medical records of children with encephalopathy admitted to the PICU of the Hong Kong Children’s Hospital from April 2019 to May 2020. Results: We identifeid altogether 24 admissions. The median (interquartile range) age was 10.0 (14.7) years and 62.5% were male. Confusion (66.7%) was the most common presentation. Drug adverse effect (33.3%) and metabolic disease (20.8%) were the predominant causes of encephalopathy. Methotrexate accounted for most of the medication-associated encephalopathy (37.5%), while Leigh syndrome, pyruvate dehydrogenase deficiency and Wernicke’s encephalopathy accounted for those with metabolic disease. The median Glasgow comatose scale on admission was 12.5 (9.0). Anti-microbials (95.8%) and anti-epileptic drugs (60.9%) were the most frequently given treatment. Children aged ≤2 years old were all male (p=0.022) and had a higher proportion of primary metabolic disease (p=0.04). Drug reaction only occurred in older children. The mortality was 8.3% and over half of the survivors had residual neurological disability upon PICU discharge. Primary metabolic disease (p=0.002), mechanical ventilation (p=0.019), failure to regain GCS back to baseline level (p=0.009) and abnormal cognitive function on admission (p=0.03) were associated with cerebral function impairment on PICU discharge.Conclusions: Primary metabolic encephalopathy was prevalent in younger children, whereas drug-induced encephalopathy was common among older oncology patients. Children survived PICU admission carried significant neurologic morbidity. Failure to regain baseline GCS was associated with poor neurological outcomes.