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Abstract Background Nutritional interventions are a key strategy for sustaining general health in children with neurological impairment. Whey-based formulae have been shown to reduce gastroesophageal reflux and accelerate gastric emptying. Casein protein, on the other hand, precipitates in the stomach's acidic environment, slowing down gastric emptying. Methods This is a prospective observational study that included 34 children with severe neurological impairment between 2–14 years old of both sexes who underwent percutaneous endoscopic gastrostomy (P.E.G) tube insertion, gastrointestinal dysfunction symptoms and nutritional status were compared after 6 months between those fed either peptide-based (100% whey) or casein-based formula. We aimed in the current study to determine whether peptide-based formula reduces gastroesophageal reflux episodes and improves symptoms of poor feeding tolerance compared to casein-based formula, and to evaluate the impact of both formulae on the nutritional status of those children. Results Using peptide-based, 100% whey protein formula was associated with improved feeding tolerance and reduced gastrointestinal issues such as constipation (p-value = 0.016), reflux, and vomiting episodes (p-value = 0.034). Unlike patients who obtained the casein-based formula, patients who received the peptide-based formula exhibited significant improvement in swallowing ability 6 months after PEG insertion when compared to pre-insertion (p-value = 0.002). Conclusion Whey-based formula is better recommended for neurologically impaired children who have poor swallowing abilities, constipation, reflux, and vomiting episodes.

Central pontine myelinolysis (CPM) is a notorious grave complication of rapid correction of hyponatremia. CPM is a noninflammatory demyelination. It presents clinically with variable degrees of loss of coordination, unconsciousness, blurred vision, cranial nerve affection, progressive spasticity, quadriparesis, pseudo bulbar palsy up to locked in syndrome, coma and death. We report a 4.5-year-old who presented to emergency room (ER) with generalized tonic-clonic seizures, and sepsis. His parents reported that he underwent un-eventful tonsillectomy 3 days earlier. Two days post-tonsillectomy he developed fever. On third day post-tonsillectomy he developed an attack of convulsions at home, 3 hours prior to presenting to ER. He presented to the ER by another attack of seizures. His seizures were controlled on IV midazolam and levetiracetam loading dose. His conscious level was clouded beyond the postictal 30 minutes. His Glasgow Coma scale was 12 which necessitated Pediatric Intensive Care Unit (PICU) admission. His condition was complicated by acute liver and kidney injury that improved within 48 hours. Upon admission his sodium level was 141 mmol/L, and did not drop below 140 mmol/L all through the hospital stay. By the 7th day after admission the child developed left sided convergent squint (6th cranial nerve palsy) and progressive spasticity. Magnetic resonance imaging revealed CPM. The isolated CPM in this child developed irrespective of hemodynamic stability, lack of hyponatremia and its rapid correction. CPM in our studied child might be an isolated presentation of sepsis associated encephalopathy, or a late complication post-tonsillectomy.

Background: Congenital heart disease represents a common type of birth defects. Cardiac surgery required for correction of these congenital anomalies may result in multiple neurological complications during or after surgery either transient or permanent. Aim of the Work: To determine the frequency and the outcome of the short term neurological complications in children undergoing congenital heart disease surgery. Patients and Methods: An observational prospective study was conducted in the postoperative cardiac Pediatric Intensive Care Unit (PICU) in Cairo University Children Hospital. It included 105 patients from 1 month to 12 years who underwent surgery for correction of the congenital heart disease. Follow up of the patients who developed neurological complications for 3 months post discharge from PICU was done to assess the outcome. Results: 16 patients (15.2%) developed acute neurological complications. Seizures were in 11 patients, 3 of them had associated disturbed conscious level (DCL) and stroke. Delayed recovery of consciousness was found in 6 patients, 5 of them were associated with seizures. Intensive care unit acquired weakness (ICUAW) was reported in 5 patients. Five patients with seizures were discharged, 3 of them with regressive course post discharge where seizures were controlled on a single antiepileptic drug (AED) and the other 2 with progressive course that necessitated addition of another AED. Four patients with ICUAW had regressive course post discharge. Conclusion: Acute neurological complications post congenital heart diseases surgery are serious morbidities and are associated with high risk of mortality. Primary prevention of these complications by using neuroprotective measures and avoiding the development of shock, and infection beside reduction of hospital stay can be helpful in decreasing incidence of complications and improving outcome among those patients.