title: Selective head cooling for the treatment of neurologic complications of acute liver failure in a newborn with disseminated herpes infection.
abstract: BACKGROUND
  Neurologic complications of pediatric acute liver failure (ALF) are a major determinant of outcome. Management of these complications, including increased intracranial pressure (ICP) is largely supportive. Although hypothermia is an effective treatment for perinatal asphyxia and is used to reduce ICP following traumatic brain injury, it has not been evaluated for neurologic complications of ALF in the newborn.
  
  
  METHODS
  Case report.
  
  
  RESULTS
  We present a case of neonatal herpes simplex virus (HSV)-associated ALF with profound neurologic impairment and increased ICP. The patient was treated with selective head cooling, and monitored with transcranial doppler (TCD) studies of cerebral blood flow velocity, and electroencephalograms (EEG). The duration of head cooling was influenced by absent diastolic flow on TCDs, which subsequently improved during hypothermia. Continuous EEGs captured subclinical seizures, which improved with antiepileptic medications. Her death was attributed to a massive pulmonary hemorrhage and a hypoxemic cardiac arrest secondary to significant coagulopathy.
  
  
  CONCLUSIONS
  This case demonstrates that selective head cooling may attenuate increased ICP in neonatal encephalopathy, and that TCDs may guide management in the absence of invasive monitoring.
authors.affiliation: Department of Pediatrics, Ruth D. & Ken M. Davee Pediatric Neurocritical Care Program, Ann & Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, IL 60611 USA.
authors.forename: Gregory
authors.initials: G
authors.lastname: Hansen
authors.forename: Michele
authors.initials: M
authors.lastname: Grimason
authors.forename: James W
authors.initials: JW
authors.lastname: Collins
authors.forename: Mark S
authors.initials: MS
authors.lastname: Wainwright
keywords: Acute liver failure; EEG; Hypothermia; Neonate; Transcranial doppler