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The data on intensive care treatment of pediatric refractory status epilepticus are of poor quality, yet they show a hierarchy in strategies: early midazolam, then barbiturates, and then trial of other anesthetic strategies. In addition, using a solely clinical endpoint for seizure control may be missing significant seizure burden in pediatric refractory status epilepticus.

Background Currently, scant data exists regarding ECMO support in neonates with herpes virus infection. Objectives We investigated outcomes among neonates with herpes virus infection reported to the Extracorporeal Life Support Organization (ELSO) registry and analyzed factors associated with death prior to hospital discharge with this virus. Design Retrospective analysis of ELSO registry dataset from 1985–2005. Setting 114 ECMO centers contributing data to the ELSO registry. Patients Patients 0–31 days of age with herpes simplex virus infection supported with ECMO and reported to the ELSO registry. Interventions None Methods Clinical characteristics, outcomes, and factors associated with death prior to hospital discharge were investigated for patients in the virus group. Kaplan-Meier estimates of survival to hospital discharge according to virus type were investigated. Measurements and Main Results Newborns with HSV infection requiring ECMO support demonstrated much lower hospital survival rates (25%). Clinical presentation with septicemia/ shock was significantly associated with mortality for the HSV group on multivariate analysis. There was no difference in HSV mortality when comparing two era’s (≥ 2000 versus < 2000). Conclusions In this cohort of neonatal patients with overwhelming infections due to HSV who were supported with ECMO, survival was dismal. Patients with disseminated HSV infection presenting with septicemia/ shock are unlikely to survive, even with aggressive extracorporeal support.

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