Objectives Children with hypoxic brain injuries have been considered to make poorer recovery than children with traumatic brain injuries. We aim to highlight that early rehabilitation may contribute to better outcomes than widely appreciated.
Methods Retrospective study. Setting: two hospitals in the UK with paediatric intensive care units (ICU) and neurorehabilitation wards. Inclusion criteria: children under 16 years; admitted to ICU for ventilation; encephalopathy following cardiorespiratory arrest January 2010 to December 2014; survived to discharge from ICU. Exclusion criteria: children under 1 year of age; cardiorespiratory arrest following trauma.
Results 16 children (8 male) were identified. Mean age: 99 months. Causes of cardiorespiratory arrest: strangulation (3); hypovolaemia (2); near-drowning (2); peri-operative (2); cardiac arrhythmia or unexplained (3); asthmatic arrest (2); other (2). Return of spontaneous cardiac output was 15 min or more in 11 out of 16 children. Mean length (SD) of stay on ICU: 11.5 (12.4) days. Eleven children had bilateral basal ganglia injury with varying cortical involvement; no imaging abnormality was identified in one child. Six children required prolonged parenteral nutrition or gastrostomy; two required ileo-colectomy; three children required tracheostomy. Four children required re-admission to ICU or high dependency care. Movement disorders requiring medications (baclofen, diazepam, L-Dopa) were common. Discharge from hospital occurred at median (range) 107 (9–706) days after injury. Ten children were discharged home directly. Discharge KOSCHI score was 3B (severe disability) or worse in nine children; four children were at 5A or 5B (good recovery). 60% of children were sitting independently 150 days and walking independently 500 days post injury. Duration of cardiac arrest did not alter outcomes but mode of injury played a more significant role in predicting outcome.
Conclusions Severe disability or vegetative state after hypoxic encephalopathy is a frequent, but not inevitable outcome in children who survive to discharge from ICU. This group of children often require several months of inpatient admission to achieve medical stability during which time they are capable of active participatory rehabilitation. There is some potential for continued improvement following discharge.
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