Selective head cooling for the treatment of neurologic complications of acute liver failure in a newborn with disseminated herpes infection

Gregory Hansen,Michele Grimason,Mark S Wainwright,James W Collins

doi:10.1186/2193-1801-2-572

Gregory Hansen, Michele Grimason + Show 2 more

Open Access

https://doi.org/10.1186/2193-1801-2-572

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Abstract

BackgroundNeurologic complications of pediatric acute liver failure (ALF) are a major determinant of outcome. Management of these complications, including increased intracranial pressure (ICP) is largely supportive. Although hypothermia is an effective treatment for perinatal asphyxia and is used to reduce ICP following traumatic brain injury, it has not been evaluated for neurologic complications of ALF in the newborn.MethodsCase report.ResultsWe present a case of neonatal herpes simplex virus (HSV)-associated ALF with profound neurologic impairment and increased ICP. The patient was treated with selective head cooling, and monitored with transcranial doppler (TCD) studies of cerebral blood flow velocity, and electroencephalograms (EEG). The duration of head cooling was influenced by absent diastolic flow on TCDs, which subsequently improved during hypothermia. Continuous EEGs captured subclinical seizures, which improved with antiepileptic medications. Her death was attributed to a massive pulmonary hemorrhage and a hypoxemic cardiac arrest secondary to significant coagulopathy.ConclusionThis case demonstrates that selective head cooling may attenuate increased ICP in neonatal encephalopathy, and that TCDs may guide management in the absence of invasive monitoring.

Highlights

acute liver failure (ALF) in children is rare, and results in death or need for liver transplantation (LT) in nearly 50% of cases (Squires et al 2006)
Among children with ALF who develop hepatic encephalopathy (HE), fewer than 20% with HE survive without LT (Rivera-Penera et al 1997)
We present a case of neonatal HSVassociated ALF with profound neurologic impairment and increased intracranial pressure (ICP), treated with selective head cooling (Gluckman et al 2005) and monitored with transcranial doppler (TCD) studies of cerebral blood flow velocity (Aggarwal et al 2008)

Summary

Introduction

ALF in children is rare, and results in death or need for liver transplantation (LT) in nearly 50% of cases (Squires et al 2006). Management of neurologic complications of ALF, including increased intracranial pressure (ICP) in children is largely supportive. Hypothermia is a safe and effective treatment for perinatal asphyxia (Shankaran et al 2005; Azzopardi et al 2009; Gluckman et al 2005; Lin et al 2006), but has not been evaluated for the management neurologic complications of ALF in the newborn.

Results

Conclusion