Masahiro Nishiyama1, Tsukasa Tanaka1, Kyoko Fujita1, Azusa Maruyama1, Hiroaki Nagase2. 1. Department of Neurology, Hyogo Prefectural Kobe Children's Hospital, Kobe, Hyogo 654-0081, Japan. 2. Department of Neurology, Hyogo Prefectural Kobe Children's Hospital, Kobe, Hyogo 654-0081, Japan. Electronic address: nagasehiroaki@msn.com.
Abstract
BACKGROUND: Acute encephalopathy is a leading cause of mortality and neurological sequelae in children. Although many strategies have been proposed, effective therapies have not yet been established. The objective of this retrospective study was to assess the effectiveness of targeted temperature management in children with acute encephalopathy. METHODS: We retrospectively evaluated the clinical courses and outcomes of 57 children who were consecutively admitted at Kobe Children's Hospital between October 2002 and August 2011. These children had acute encephalopathy with serum aspartate aminotransferase (AST) levels below 90 IU/l within 6h of onset. We compared the clinical characteristics and neurological outcomes of children treated with targeted temperature management and those who received conventional care. Targeted temperature management was defined as temperature control (34.5-36°C) with intubation, and the continuous use of anticonvulsants and muscle relaxants induced within 24 h of onset. Outcome was measured using the Pediatric Cerebral Performance Category Scale with grade 1 representing a good clinical outcome and grades 2-6 reflecting poor outcomes. RESULTS: Outcomes were good in all children treated with targeted temperature management (n=23) as well as in 24 out of the 34 children who received conventional care (p=0.004). The age, gender, refractory status epilepticus rate, prolonged neurological abnormality rate, preceding infection rate, and laboratory results were not significantly different between the two groups. CONCLUSIONS: We determined that targeted temperature management could improve outcome in acute encephalopathy without AST elevation.
BACKGROUND: Acute encephalopathy is a leading cause of mortality and neurological sequelae in children. Although many strategies have been proposed, effective therapies have not yet been established. The objective of this retrospective study was to assess the effectiveness of targeted temperature management in children with acute encephalopathy. METHODS: We retrospectively evaluated the clinical courses and outcomes of 57 children who were consecutively admitted at Kobe Children's Hospital between October 2002 and August 2011. These children had acute encephalopathy with serum aspartate aminotransferase (AST) levels below 90 IU/l within 6h of onset. We compared the clinical characteristics and neurological outcomes of children treated with targeted temperature management and those who received conventional care. Targeted temperature management was defined as temperature control (34.5-36°C) with intubation, and the continuous use of anticonvulsants and muscle relaxants induced within 24 h of onset. Outcome was measured using the Pediatric Cerebral Performance Category Scale with grade 1 representing a good clinical outcome and grades 2-6 reflecting poor outcomes. RESULTS: Outcomes were good in all children treated with targeted temperature management (n=23) as well as in 24 out of the 34 children who received conventional care (p=0.004). The age, gender, refractory status epilepticus rate, prolonged neurological abnormality rate, preceding infection rate, and laboratory results were not significantly different between the two groups. CONCLUSIONS: We determined that targeted temperature management could improve outcome in acute encephalopathy without AST elevation.