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Polyneuropathy in Critically Ill Mechanically Ventilated Children: Experience From a Tertiary Care Hospital in North India*

Shubham, Shantanu MBBS1; Dhochak, Nitin MD1; Singh, Akanksha MD2; Patel, Sanjay Kumar MD2; Chakrabarty, Biswaroop DM1; Sankar, Jhuma MD1; Gulati, Sheffali MD1; Kabra, S. K. MD1; Jaryal, Ashok Kumar MD2; Lodha, Rakesh MD1

Pediatric Critical Care Medicine: September 2019 - Volume 20 - Issue 9 - p 826-831
doi: 10.1097/PCC.0000000000002012
Neurocritical Care
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Objectives: To determine the prevalence of critical illness polyneuropathy and its risk factors in critically ill children mechanically ventilated for 7 days or more.

Design: Observational cohort study.

Setting: PICU of a tertiary care hospital from North India.

Patients: Children 1–15 years old admitted in PICU from June 2016 to September 2017, mechanically ventilated for 7 days or more, excluding those with diagnosed neuromuscular disease, stroke, or spinal pathology.

Intervention: Demographic details, diagnosis, treatment details, and anthropometry at admission and enrolment were recorded. Nerve conduction studies were performed after enrolment and repeated a week later, if the child was still in PICU. Medical Research Council scoring for muscle strength was performed in survivors. Risk factors including Pediatric Index of Mortality-2 score, sepsis, multiple organ dysfunction, hypoalbuminemia, use of steroids, neuromuscular-blocking agents, and vasopressors were recorded. Samples for the level of micronutrients (copper, zinc, folate, and vitamin B12) were collected at the time of enrolling the child and at the time of discharge.

Measurements and Main Results: Thirty-two children were enrolled, of whom 29 had features of critical illness polyneuropathy on evaluation at day 8 of mechanical ventilation (prevalence, 90.6% [95% CI, 80.5–100%]). The polyneuropathy was axonal in 26 (81.2%), mixed in one patient (3.1%), and uncharacterized in two (6.2%). Sepsis and multiple organ dysfunction were present in 31 subjects (96.9%). No risk factors for critical illness polyneuropathy could be identified although the study was not sufficiently powered to do so. The difference between serum micronutrient levels (copper, zinc, folate, and vitamin B12) between patients who developed polyneuropathy, and those who did not, was statistically insignificant.

Conclusions: We observed a high prevalence of critical illness polyneuropathy in children in PICU, mechanically ventilated for 7 days or more; almost all of whom had underlying sepsis.

1Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India.

2Department of Physiology, All India Institute of Medical Sciences, New Delhi, India.

*See also p. 888.

This work was conducted at the All India Institute of Medical Science, New Delhi, India.

A part of this work was accepted for poster presentation at the 9th Conference of World Federation of Pediatric Intensive and Critical Care Societies (WFPICCS), June 9-3, 2018, in Singapore.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (http://journals.lww.com/pccmjournal).

The authors have disclosed that they do not have any potential conflicts of interest.

For information regarding this article, E-mail: rakesh_lodha@hotmail.com

Copyright © 2019 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies