Severe encephalitis: aetiology, management and outcomes over 10 years in a paediatric intensive care unit.

Abstract

OBJECTIVE:

To describe the characteristics, differential diagnoses, management and outcomes of severe encephalitis in children.

DESIGN:

A 10-year retrospective cohort study in children admitted to a tertiary paediatric intensive care unit (PICU) with suspected encephalitis. One to 6 months' follow-up data were compared between different categories.

PARTICIPANTS:

Patients from 0 to 17 years of age with acute encephalopathy and one or more of fever, seizure, focal neurological findings, cerebrospinal fluid abnormalities, EEG/neuroimaging consistent with encephalitis.

MAIN OUTCOME MEASURES:

Epidemiology, clinical features, outcomes and risk factor analysis.

RESULTS:

175 children with encephalitis required intensive care unit (ICU) admission over 10 years. The median age was 4.5 months (IQR 1.6-54.8). The leading cause was enterovirus (n=49, 28%), followed by parechovirus, influenza, herpes simplex virus (HSV), human herpesvirus-6 (HHV-6), Streptococcus pneumoniae, acute-disseminated encephalomyelitis and anti-N-methyl-D-aspartate-receptor-associated encephalitis. Immune-mediated encephalitis had higher prevalence in females, older age and longer duration of encephalopathy. Mechanical ventilation was required by 74 children (42%); haemodynamic support by 28 children (16%), 3 received extracorporeal membrane oxygenation (ECMO) support. Eleven patients died (case fatality rate 6.3%): five with HHV-6, two enterovirus, two influenza, one HSV, one human-metapneumovirus. At follow-up, 34 children had mild or moderate disability, and six severe disability. In a multivariable logistic regression model, three factors were associated with severe disability or death: age <2 years old (OR 8.2, CI 1.0 to 67.2), Herpesviridae aetiology (OR 14.5, CI 1.2 to 177.3) and length of intubation (OR 1.005, CI 1.00 to 1.01).

CONCLUSIONS:

Encephalitis has a varied aetiology and causes death or severe disability in 1 in every 10 children requiring intensive care.

• Authors: Giordano Palmas, Trevor Duke
• Journal: Archives of disease in childhood (Arch Dis Child) Vol. 108 Issue 11 Pg. 922-928 (11 2023) ISSN: 1468-2044 [Electronic] England
• PMID: 37487693 (Publication Type: Journal Article)
• Copyright: © Author(s) (or their employer(s)) 2023. No commercial re-use. See rights and permissions. Published by BMJ.

Topics

• Child
• Female
• Humans
• Infant
• Child, Preschool
• Influenza, Human (complications)
• Retrospective Studies
• Encephalitis (diagnosis, epidemiology, etiology)
• Intensive Care Units, Pediatric
• Enterovirus Infections (complications, diagnosis, epidemiology)
• Enterovirus
• Brain Diseases