Case ReportsCritical illness neuropathy in pediatric intensive care patients
Introduction
Critical illness neuropathy (CIN) is a primary axonal polyneuropathy recognized more frequently over the past several years in adult intensive care patients with sepsis and multiple organ dysfunction [1], [2], [3]. About 70% of these patients demonstrate electrophysiologic changes indicative of an axonal polyneuropathy, and about 30% develop clinical signs, such as flaccid tetraparesis or paraparesis, and difficulties in weaning from mechanical ventilation [2].
Although sepsis requiring intensive care treatment is a frequent complication of various diseases in childhood, the diagnosis of CIN in children has rarely been established. Within 10 months, two children (2 years, 6 months of age and 6 years, 6 months of age) with CIN were observed in our pediatric intensive care unit. Clinical and electrophysiologic data are presented and important differential diagnoses discussed to contribute to the understanding of CIN in childhood.
Section snippets
Patient 1
After a traffic accident that resulted in a skull fracture and left temporoparietal brain contusion, a previously healthy male 6 years, 6 months of age was treated under intracranial pressure monitoring by deep analgesia and sedation (fentanyl, midazolam) and mild hyperventilation because of diffuse brain edema. He received pancuronium for muscle relaxation for 4 days and was fed using a nasogastric tube with 60-80 kcal/kg daily. Vitamin B complex was provided intravenously. Computed tomography
Discussion
Several investigations during the past 20 years revealed that a significant number of adult patients with sepsis and multiple organ dysfunction develop CIN [1], [2], [3]. Although sepsis requiring intensive care treatment is also a frequent complication of various diseases in childhood, only a few case reports of children with CIN have been published [4], [5], [6], [7].
According to the studies of critically ill adult patients, CIN is characterized by a rapidly developing flaccid tetra- or
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