Predicting the outcomes of targeted temperature management for children with seizures and/or impaired consciousness accompanied by fever without known etiology

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. 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. 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. 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.

Detailed characteristics of acute encephalopathy with biphasic seizures and late reduced diffusion: 18-year data of a single-center consecutive cohort

“…In our hospital, AEDs for febrile status epilepticus were administered on an individual basis according to our hospital protocols [12]. Targeted temperature management (TTM) was induced based on the following criteria: 1) refractory status epilepticus; 2) elevated aspartate transaminase (AST) levels within 6 h of disease onset; and 3) impaired consciousness lasting longer than 6 h [10,11]. Central sparing was defined as restricted DWI that spared the perirolandic region on MRI.…”

Early steroid pulse therapy for children with suspected acute encephalopathy

“…Patients with stable cardiovascular dynamics were intubated and underwent TTM under general anesthesia as previously reported. [ 15 ] The targeted temperature of the regimen was 34.5 ± 0.5°C before December 2005 and 36.0 ± 0.5°C after January 2006. Moreover, patients with AST > 90 IU/L underwent a mitochondrial drug cocktail after March 2016.…”

“…We administered methylprednisolone 30 mg/kg (maximum 1000 mg) as steroid pulse therapy for 3 days; subsequently, we administered oral prednisolone for 4 days. Patients with stable cardiovascular dynamics were intubated and underwent TTM under general anesthesia as previously reported [15] . The targeted temperature of the regimen was 34.5 ± 0.5°C before December 2005 and 36.0 ± 0.5°C after January 2006.…”