• Wun Fung Hui, Karen Ka Yan Leung, Cheuk Chung Au, Cheuk Wing Fung, ChengFrankie W TFWTFrom the Department of Paediatrics and Adolescent Medicine., Elaine Kan, and HonKam Lun EllisKLEFrom the Department of ... more Paediatrics and Adolescent Medicine.. less
• From the Department of Paediatrics and Adolescent Medicine.
• Pediatr Emerg Care. 2022 Mar 1; 38 (3): 115120115-120.

AimChildhood encephalopathy comprises a wide range of etiologies with distinctive distribution in different age groups. We reviewed the pattern of encephalopathy admitted to the pediatric intensive care unit (PICU) of a tertiary children's hospital.MethodsWe reviewed the medical records and reported the etiologies, clinical features, and outcomes of children with encephalopathy.ResultsTwenty-four admissions to the PICU between April 2019 and May 2020 were reviewed. The median (interquartile range) age was 10.0 (14.7) years and 62.5% were boys. Confusion (66.7%) was the most common presentation. Adverse effects related to medications (33.3%) and metabolic disease (20.8%) were predominant causes of encephalopathies in our study cohort. Methotrexate was responsible for most of the medication-associated encephalopathy (37.5%), whereas Leigh syndrome, pyruvate dehydrogenase deficiency and Wernicke's encephalopathy accounted for those with metabolic disease. The median Glasgow Coma Scale (GCS) on admission was 12.5 (9.0). Antimicrobials (95.8%) and antiepileptic drugs (60.9%) were the most frequently given treatment. Children aged 2 years or younger were all boys (P = 0.022) and had a higher proportion of primary metabolic disease (P = 0.04). Intoxication or 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.ConclusionsPrimary metabolic encephalopathy was prevalent in younger children, whereas drug-induced toxic encephalopathy was common among older oncology patients. Survivors have significant neurologic morbidity. Failure to regain baseline GCS was a poor prognostic factor for neurological outcomes.Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.

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