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Titolo:
Survivors with bad outcome after hypoxic-ischaemic encephalopathy: full-term neonates compare unfavourably with children
Autore:
Pfenninger, J; Bachmann, D; Wagner, BP;
Indirizzi:
Inselspital Bern, Univ Childrens Hosp, Abt Padiatr Intens Behandlung, Paediat Intens Care Unit, CH-3010 Bern, Switzerland Inselspital Bern Bern Switzerland CH-3010 nit, CH-3010 Bern, Switzerland
Titolo Testata:
SWISS MEDICAL WEEKLY
fascicolo: 19-20, volume: 131, anno: 2001,
pagine: 267 - 272
SICI:
1424-7860(20010519)131:19-20<267:SWBOAH>2.0.ZU;2-K
Fonte:
ISI
Lingua:
ENG
Soggetto:
INTENSIVE-CARE UNIT; CLINICAL COURSE; ISCHEMIC ENCEPHALOPATHY; INFANTS; DISTRESS; DEATH; BIRTH;
Keywords:
hypoxic-ischaemic encephalopathy; full-term neonate; child; outcome; ethics; withdrawal of life support;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Citazioni:
26
Recensione:
Indirizzi per estratti:
Indirizzo: Pfenninger, J Inselspital Bern, Univ Childrens Hosp, Abt Padiatr Intens Behandlung, Paediat Intens Care Unit, CH-3010 Bern, Switzerland Inselspital Bern Bern Switzerland CH-3010 ern, Switzerland
Citazione:
J. Pfenninger et al., "Survivors with bad outcome after hypoxic-ischaemic encephalopathy: full-term neonates compare unfavourably with children", SWISS MED W, 131(19-20), 2001, pp. 267-272

Abstract

Hypoxic-ischaemic encephalopathy (HIE) is of major importance in neonatal and paediatric intensive care with regard to mortality and long-term morbidity. Our aim was to analyse our data in full-term neonates and children with special regard to withdrawal of life support and had outcome. Patients: All patients with HIE admitted to our unit from 1992-96 were analysed. Criteria for HIE were presence of a hypoxic insult followed bq coma or altered consciousness with or without convulsions. Severity of HIE was assessed in neonates using Sarnat stages, and in children the duration of coma. In the majority of cases staging was completed with electrophysiological studies. Outcome was described using the Glasgow Outcome Scale. Bad outcome was defined as death, permanent vegetative state or severe disability good outcome as moderate disability or good recovery. Results: In the neonatal group (n = 38) outcome was significantly associated with Sarnat stages, presence of convulsions, severely abnormal EEG, cardiovascular failure, and multiple organ dysfunction (MOD). A bad outcome wasobserved in 27 cases with 14 deaths and 13 survivors. Supportive treatmentwas withdrawn in 14 cases with 9 subsequent deaths. In the older age group(n = 45) outcome was related to persistent coma of 24-48 h, severely abnormal EEG, cardiovascular failure, liver dysfunction and MOD. A bad outcome was found in 36 cases with 33 deaths and 3 survivors. Supportive treatment was withdrawn in 15 instances, all followed by death. Conclusions: Overall, neonates and older patients did not differ with regard to good or bad outcome. However, in the neonatal group there were significantly more survivors with bad outcome, either overall or after withdraw al of support. Possible explanations for this difference include variabilityof hypoxic insult, maturational and metabolic differences, and the more compliant neonatal skull, which prevents brainstem herniation.

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Documento generato il 28/01/20 alle ore 21:09:12