White Matter Tract Pathology in Pediatric Anoxic Brain Injury from Drowning

Long-Term Neurocognitive Outcomes in Pediatric Nonfatal Drowning: Results of a Family Caregiver Survey

BACKGROUND

Drowning is a leading cause of brain injury in children. Long-term outcome data for drowning survivors are sparse. This study reports neurocognitive outcomes for 154 children hospitalized following drowning.

METHODS

A survey for parent caregivers was distributed online. Likert scale items assessed 10 outcome variables in four domains: motor (three), perception (three), language (three), and social/emotional (one). Cluster analysis, outcome relative risk, and descriptive statistics were applied.

RESULTS

Of 208 surveys received, 154 met inclusion criteria. Coma was the most common admission status (n = 137). Cluster analysis identified three outcome groups: Mild (n = 39), Moderate (n = 75), and Severe (n = 40). Motor impairment with cognitive and perceptual sparing (deefferentation) was present in Moderate (P < 1 × 10-26) and Severe (P < 1 × 10-12) but absent in Mild. Locked-in state was endorsed in both Moderate (83%) and Severe (70%). The strongest predictor of good outcome (Mild) was hospitalization with no medical intervention (relative risk [RR] = 6.7). Responsivity on admission (RR = 4.2) or discharge (RR = 12.22) also predicted good outcome. In-hospital prognostication and counseling predicted outcome weakly (RR = 1.3) or not at all.

CONCLUSIONS

Long-term outcomes in pediatric drowning ranged widely. Overall, motor impairments exceeded perceptual or cognitive (P < 1 × 10-18), with "locked-in state" endorsed in most (93 of 154). The strongest predictors of good outcome were the lack of necessity for interventions and responsivity on admission or discharge. The eponym "Conrad syndrome" is proposed for locked-in state following nonfatal drowning in children.

Hypothesized mechanisms of death in swimming: a systematic review

BACKGROUND

The study aims to update the specific classification of mechanisms of death in swimming and to demonstrate these categories are reasonable, by analyzing more characteristics of death cases, evaluating the available evidence and determining their quality.

METHODS

Original articles were queried from PubMed, Web of Science, Embase databases, Cochrane Library, and Scopus. Included studies, which were evaluated as level 4 evidence or higher according to the Oxford Centre for Evidence-Based Medicine, discussed hypothesized mechanisms of death in swimming. Parameters analyzed in this study included decedents' characteristics, outcome measures, findings, methodological index for non-randomized studies (MINORS), and critical evaluation of each study classified by death mechanism.

RESULTS

A total of twenty-five studies were included for further analysis: fourteen were associated with cardiovascular diseases, two were about cerebrovascular diseases, two contained respiratory diseases, seven were about hazardous conditions and three contained other drownings, which provided evidence for mechanisms of death.

CONCLUSIONS

It is found that cardiovascular disease is the main cause or contributing factor of death in swimming. Respiratory diseases and cerebrovascular diseases are difficult to be definitive mechanism categories due to insufficient evidence. Hazardous conditions appear to be one of the possible risk factors because there are more cases of deaths from unsafe environments in swimming, but further statistics and research are still needed to support this view. Our study may have important implications for developing potential prevention strategies for sports and exercise medicine.

TRIAL REGISTRATION

PROSPERO ID (CRD42021267330). Registered Aug 13th 2021.

Descriptive Epidemiology of Pediatric Drowning Patients Presenting to a Large Southern US Children's Hospital

OBJECTIVES

Drowning is the leading cause of death for children ages 1 to 4, and it is among the leading causes of death for children of all ages. National data show disparities in drowning risk for certain racial groups. This study aimed to describe characteristics of patients presenting after a drowning event to guide focused drowning prevention outreach efforts.

METHODS

This was a retrospective chart review study designed to analyze the epidemiologic and demographic characteristics of drowning-related injuries and deaths that presented to a large, urban, southern US pediatric hospital from 2016 to 2019. All patients aged 0 to 19 years were identified using International Classification of Diseases, Ninth Revision and Tenth Revision codes for drowning or submersion injuries.

RESULTS

One hundred sixty-two patients met the inclusion criteria for the study. Submersion injuries were most common in the 1- to 5-year-old age group. Fifty-eight percent of patients were male. The analysis of race showed that 65% of patients were White and 33% of patients were Black. Pools were the setting for 78% of drowning events. Fifty-four percent of patients received cardiopulmonary resuscitation. Sixty-four percent of patients required hospitalization after the injury.

CONCLUSIONS

Characteristics of drowning victims may vary significantly from national data, depending on the area involved. This finding highlights the need for assessing local data to better inform local outreach. Further research is necessary to understand why such variance exists. Drowning prevention education, tailored toward pool safety and preschool-age children, should be a focus of injury prevention efforts.

Intrauterine cytomegalovirus infection: a possible risk for cerebral palsy and related to its clinical features, neuroimaging findings: a retrospective study

Background

Abundant clinical evidences indicate that the increased risk of cerebral palsy (CP) may be associated with the intrauterine exposure to maternal infection. Cytomegalovirus (CMV) is a common cause of CP. However, little is known about the relationship between the intrauterine exposure of the fetus to CMV infection and CP. This study aims to explore the relationships between intrauterine CMV infection and clinical symptoms, classification, intelligence development and brain neuroimaging findings in children with CP.

Methods

In this study, 147 children with CP in recent 6 years were retrospectively analyzed (average age: 14.76 ± 3.07months; sex (M/F): 103/44). 148 children had CMV IgG and IgM positive sera identified by TORCH examination were selected as the control group (average age: 15.10 ± 3.21months; sex (M/F): 102/46), which also undergo the examination of CMV-DNA in urine. The age and sex of children in the control group were matched with those in the CP group. CMV-DNA in urine was detected by CMV fluorescence quantitative PCR, and t-test was performed to analyze the number of copies. For the CP group, standardized rehabilitation treatment was performed and the function of gross motor was evaluated by GMFM scale before and after treatment. The Gesell developmental scale (GDS) was used to assess the level of intellectual development. The classification of CP was conducted and the results of magnetic resonance imaging were analyzed. Finally, the correlations between the copy number of CMV-DNA and the clinical characteristics of children with CP were evaluated by the method of Pearson and Spearman correlation analysis.

Results

The level of CMV infection was negatively correlated with the developmental quotient (DQ) of children with CP. Negative association was found between the level of CMV infection and the level of the gross motor development. The level of CMV infection was positively related with the occurrence probability of spastic quadriplegia. However, no associations were found between the abnormalities of brain tissue and the number of CMV copies. Moreover, CMV infection might add the difficulty of the rehabilitation treatment.

Conclusions

CMV infection is a risk factor for the occurrence of CP in children. Pregnancy examination should be strengthened. Early detection and control of CMV infection may contribute to the rehabilitation of children with CP and reduce the disability and social burden.

Defining catastrophic brain injury in children leading to coma and disorders of consciousness and the scope of the problem

PURPOSE OF REVIEW

Severe brain injury in children resulting in coma and disorders of consciousness (DOC) is a catastrophic event for the life and function of children and their families. The present article summarizes the recently published pediatric literature on validated diagnostic assessments, potential predictors of recovery, and outcome measures used in children with catastrophic brain injury (CBI). Literature search terms included variants of consciousness, diagnostic tests, predictors of outcome, and outcome measures.

RECENT FINDINGS

Developmentally appropriate diagnostic tools, outcome predictors, and outcome measures are lacking for children with CBI leading to coma and DOC. Individual case prognosis relies on serial clinical examinations and experience. Evidence regarding optimal diagnosis of the highest level of consciousness and management of children with CBI is needed. Global efforts through the ongoing Curing Coma Campaign are aimed at: developing common data elements for information capture; streamlining the classification of coma endotypes; describing trajectories with biomarkers to monitor recovery or disease progression; and devising effective treatments for adults and children.

SUMMARY

Standardized, developmentally appropriate diagnostic and outcome assessments for CBI in children are needed. Future research should use these content standards to update our understanding of children with CBI leading to coma and DOC, and evaluate effective practices using acute adjunctive and rehabilitation therapies.

Lifetime Traumatic Experiences and Disordered Eating among University Students: The Role of Posttraumatic Stress Symptoms

The associations between lifetime traumatic events (TEs), posttraumatic stress (PTS) symptoms, and disordered eating (DE) were studied in a sample of 614 university students (mean age 20 years). An anonymous questionnaire included 32 lifetime TEs, IES-revised measured PTS symptoms, and EAT-26 evaluated DE symptoms. Statistical analyses included Pearson correlations and structural equation models (SEM) with bootstrapping method. Findings reveal the prevalence of DE in 8.1% of participants, while 73.9% of students experienced at least one lifetime TE. 52.0% of students with DE had PTS symptoms (p < 0.0001) and 30.8% of students with lifetime TEs had PTS symptoms (p < 0.001). In SEM, direct paths from lifetime TEs to PTS symptoms (0.38, p < 0.0001) and from PTS symptoms to DE (0.40, p < 0.0001) were observed. The final SEM confirmed the mediating role of PTS symptoms in the path between some TEs (traffic accident and seriously injured) and DE among the university students. If PTS symptoms are associated with DE, then addressing PTS symptoms in the context of DE treatment may improve treatment efficacy.

Functional neuroimaging after severe anoxic brain injury in children may reveal preserved, yet covert, cognitive function

A growing body of evidence has confirmed that, after severe brain injury in adults, motoric and task-dependent factors that are essential for reliable communication, frequently interfere with an accurate assessment of cognitive status. In the current study, resting state functional magnetic resonance imaging (fMRI) in children who have sustained an anoxic brain injury following a near drowning incident suggests a similar pattern; preserved cognition amidst severe motoric impairment that effectively precludes accurate clinical diagnosis at the bedside. Hum Brain Mapp 38:4832-4833, 2017. © 2017 Wiley Periodicals, Inc.

Functional integrity in children with anoxic brain injury from drowning

Drowning is a leading cause of accidental injury and death in young children. Anoxic brain injury (ABI) is a common consequence of drowning and can cause severe neurological morbidity in survivors. Assessment of functional status and prognostication in drowning victims can be extremely challenging, both acutely and chronically. Structural neuroimaging modalities (CT and MRI) have been of limited clinical value. Here, we tested the utility of resting-state functional MRI (rs-fMRI) for assessing brain functional integrity in this population. Eleven children with chronic, spastic quadriplegia due to drowning-induced ABI were investigated. All were comatose immediately after the injury and gradually regained consciousness, but with varying ability to communicate their cognitive state. Eleven neurotypical children matched for age and gender formed the control group. Resting-state fMRI and co-registered T1-weighted anatomical MRI were acquired at night during drug-aided sleep. Network integrity was quantified by independent components analysis (ICA), at both group- and per-subject levels. Functional-status assessments based on in-home observations were provided by families and caregivers. Motor ICNs were grossly compromised in ABI patients both group-wise and individually, concordant with their prominent motor deficits. Striking preservations of perceptual and cognitive ICNs were observed, and the degree of network preservation correlated (ρ = 0.74) with the per-subject functional status assessments. Collectively, our findings indicate that rs-fMRI has promise for assessing brain functional integrity in ABI and, potentially, in other disorders. Furthermore, our observations suggest that the severe motor deficits observed in this population can mask relatively intact perceptual and cognitive capabilities. Hum Brain Mapp 38:4813-4831, 2017. © 2017 Wiley Periodicals, Inc.