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Predicting the outcomes of targeted temperature management for children with seizures and/or impaired consciousness accompanied by fever without known etiology.
- Source :
-
Brain & development [Brain Dev] 2019 Aug; Vol. 41 (7), pp. 604-613. Date of Electronic Publication: 2019 Mar 28. - Publication Year :
- 2019
-
Abstract
- Background: Seizures and/or impaired consciousness accompanied by fever without known etiology (SICF) is common in the pediatric emergency setting. No optimal strategy for the management of SICF in childhood currently exists. We previously demonstrated the effectiveness of targeted temperature management (TTM) against SICF with a high risk of morbidity; however, some patients with SICF develop neurological sequelae despite TTM, which necessitate additional neuroprotective treatment. The clinical characteristics of these severe cases have not been studied. Accordingly, the aim of this study was to identify the clinical characteristics of children with SICF who exhibit poor outcomes after TTM.<br />Methods: The medical records of children admitted to Kobe Children's Hospital (Kobe, Japan) between October 2002 and September 2016 were retrospectively reviewed. Patients with SICF treated using TTM were included and divided into the satisfactory and poor outcome groups. Univariate and multivariate logistic regression analyses were used to compare clinical characteristics and laboratory findings between the two groups.<br />Results: Of the 73 included children, 10 exhibited poor outcomes. Univariate logistic regression analysis revealed that acute circulatory failure before TTM initiation, the use of four or more types of anticonvulsants, methylprednisolone pulse therapy, and an aspartate aminotransferase (AST) level ≥73 IU/L were associated with poor outcomes. Multivariate logistic regression analysis identified an elevated AST level as a significant independent predictor of a poor outcome.<br />Conclusions: An elevated AST level within 12 h of onset in children with SICF is an independent predictor of a poor outcome after TTM initiated within 24 h of onset.<br /> (Copyright © 2019 The Japanese Society of Child Neurology. Published by Elsevier B.V. All rights reserved.)
- Subjects :
- Adolescent
Anticonvulsants therapeutic use
Aspartate Aminotransferases analysis
Aspartate Aminotransferases blood
Biomarkers, Pharmacological blood
Child
Child, Preschool
Consciousness
Female
Fever etiology
Humans
Hypothermia, Induced methods
Infant
Japan
Male
Prognosis
Retrospective Studies
Seizures drug therapy
Temperature
Treatment Outcome
Fever of Unknown Origin therapy
Hypothermia, Induced adverse effects
Subjects
Details
- Language :
- English
- ISSN :
- 1872-7131
- Volume :
- 41
- Issue :
- 7
- Database :
- MEDLINE
- Journal :
- Brain & development
- Publication Type :
- Academic Journal
- Accession number :
- 30929765
- Full Text :
- https://doi.org/10.1016/j.braindev.2019.03.007