Etiology of Non-Traumatic Encephalopathy in Children Admitted to Pediatric Intensive Care Unit

Background: Non Traumatic Coma (NTC) in children is a common cause of admission in Pediatric Emergency Departments and is reported to result in high morbidity and mortality. Various etiological factors have been identified for NTC; however considerable regional diversity exists in these etiological factors. The data from developing countries cannot be generalized until more researches are reported from several different areas.Aim of the Work: To assess the etiology of non-traumatic encephalopathy in the Pediatric Intensive Care Unit (PICU) at Cairo University Children Hospital.Patients and Methods: This prospective observational study was conducted in the Pediatric Intensive Care Unit (PICU) of the Children Hospital at Cairo University over a period of 1 year. The study included 150 patients admitted in the PICU due to disturbed consciousness. All patients were subjected to detailed history-taking and thorough clinical (especially neurologic) examination. For all cases, routine investigations were done in the form of: Complete Blood Count (CBC), kidney functions, liver functions, serum ammonia, blood gases, brain CT and Fundus examination. Other investigations were individualized according to the history and examination results. For example: Cerebrospinal Fluid (CSF) analysis, expanded metabolic screen, Brain MRI, Electroencephalogram (EEG) and toxicological screening.Results: The majority of our patients were aged between one month and three years (N=110=73.3%). The mean age was 2.88±3.9 years. Eighty-one patients (81) were males representing 54% of cases and sixty-nine patients (69) were females representing 46% of cases. The most common causes were septic encephalopathy (26% of cases), followed by metabolic encephalopathy (22% of cases), CNS infections (18.7% of cases), vascular causes (10.7% of cases) and toxic causes (7.3% of cases).Conclusion: Infectious causes (septic encephalopathy and CNS infections) are the most common causes of admission to PICU with encephalopathy. Metabolic causes are also frequent and must be considered in our population due to high consanguinity rates. Early referral to Emergency Department,early diagnosis and proper management are associated with better prognosis.