Clinical and electrophysiological findings and long-term outcomes in paediatric patients with critical illness polyneuromyopathy.
BACKGROUND
Neuromuscular weakness in paediatric patients with sepsis and multiple organ dysfunction is increasingly reported. However, many aspects of neuromuscular involvement in critically ill children are not completely understood. As more patients survive the critical illness, an understanding of the long-term outcomes of this condition is needed.


OBJECTIVE
To describe clinical and electrophysiological features and evaluate the long-term outcomes in critically ill paediatric patients with neuromuscular complications.


METHODS
A case series of five critically ill children was observed prospectively for a 1-month period. Selected clinical and laboratory parameters were evaluated. Electrophysiological studies were performed during the first week and then 1 month later in order to detect signs of critical illness polyneuromyopathy (CIPM). Patients with neuromuscular involvement completed a 1-year follow-up.


RESULTS
Electrophysiological abnormalities were detected in two patients. Flaccid quadriplegia was a clinical presentation. Both children had electromyographic evidence of chronic partial denervation at follow-up, findings indicative of a preceding axonal neuropathy. Marked but incomplete recovery within 1 year after the onset of the disease occured in both patients. With a mild residual functional handicap the health-related quality of life was not significantly impaired (Barthel Index > 80).


CONCLUSIONS
In both our patients with CIPM, the long-term clinical outcome is markedly better than we expected when electromyography in the 1-year follow-up demonstrated a persistent severe chronic partial denervation. These findings can have important implications for the management and rehabilitation of paediatric intensive care survivors.
Vondracek
Petr
P
Department of Paediatric Neurology, University Hospital and Masaryk University, 625 00 Brno, Cernopolni 9, Czech Republic. pvondracek@fnbrno.cz
Bednarik
Josef
J
D000293:Adolescent; D002648:Child; D003422:Critical Care; D016638:Critical Illness; D004558:Electric Stimulation; D004576:Electromyography; D004594:Electrophysiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D018482:Muscle, Skeletal / Q000503:physiopathology; D009135:Muscular Diseases / Q000503:physiopathology / Q000628:therapy*; D009460:Neurologic Examination; D010523:Peripheral Nervous System Diseases / Q000503:physiopathology / Q000628:therapy*; D011379:Prognosis; D011446:Prospective Studies; D011782:Quadriplegia / Q000209:etiology; D012121:Respiration, Artificial; D016896:Treatment Outcome