title: Nimodipine for the prevention of cerebral vasospasm after subarachnoid hemorrhage in 12 children.
abstract: BACKGROUND
  Subarachnoid hemorrhage is a rare, but life-threatening neurological emergency. Cerebral vasospasm is a complication of subarachnoid hemorrhage that contributes significantly to morbidity and mortality. Nimodipine has been used in adults to reduce the incidence of cerebral vasospasm after subarachnoid hemorrhage and improve long-term outcomes. There are, however, no data in children.
  
  
  METHODS
  Records of children with a confirmed diagnosis of subarachnoid hemorrhage who received nimodipine between January 1, 2005 and August 31, 2013 were reviewed. Dosing of nimodipine and associated hypotensive events were recorded. Transcranial Doppler ultrasonography, cranial computerized tomography, and angiography were followed as a measure of cerebral vasospasm, rebleeding, and subsequent infarction.
  
  
  RESULTS
  Twelve children (average age 11.8 ± 3.3 years, age range 3.5 to 17.3 years) were included. Aneurysm was responsible for the highest percentage (41.7%) of subarachnoid hemorrhage events. The mean dose of oral nimodipine was 1 mg/kg every 4 hours and was associated with a high rate of hypotension requiring intervention or dose modification. Clinical outcomes while on nimodipine therapy varied; evidence of vasospasm was observed in 67%, new infarction in 33%, and rebleeding in 17%. Functional and cognitive deficits were minor in two-thirds and absent in the remaining individuals. All patients survived until hospital discharge.
  
  
  CONCLUSIONS
  Oral nimodipine after subarachnoid hemorrhage in children does not eliminate vasospasm, rebleeding, or infarction and is associated with significant hypotension. Nevertheless, clinical outcomes appear favorable relative to the adult population who receive nimodipine. Further study, with dose titration, is warranted.
authors.affiliation: Department of Pharmacy, Seattle Children's Hospital, Seattle, Washington.
authors.forename: Josh
authors.initials: J
authors.lastname: Heffren
authors.affiliation: Pediatric Intensive Unit, Department of Pharmacy, Children's Hospital Colorado, Aurora, Colorado.
authors.forename: Angela M
authors.initials: AM
authors.lastname: McIntosh
authors.affiliation: Pediatric Intensive Unit, Department of Pharmacy, Children's Hospital Colorado, Aurora, Colorado; Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Anschutz Medical Campus, Aurora, Colorado. Electronic address: pam.reiter@childrenscolorado.org.
authors.forename: Pamela D
authors.initials: PD
authors.lastname: Reiter
mesh_terms: D000293:Adolescent; D002533:Cerebral Angiography; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D009553:Nimodipine / Q000627:therapeutic use*; D012189:Retrospective Studies; D013345:Subarachnoid Hemorrhage / Q000150:complications*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D017585:Ultrasonography, Doppler, Transcranial; D014665:Vasodilator Agents / Q000627:therapeutic use*; D020301:Vasospasm, Intracranial / Q000175:diagnosis / Q000209:etiology* / Q000517:prevention & control*
chemical_list: D014665:Vasodilator Agents; D009553:Nimodipine
keywords: aneurysm; arteriovenous malformation; cerebral infarction; cerebral vasospasm; pediatric nimodipine dosing; rebleeding events; subarachnoid hemorrhage