[Hypoxic-ischemic coma in children. Factors related to the prognosis].

OBJECTIVE: The purpose of this study was to analyze the etiology, evolution and predictive value of clinical variables and complementary explorations in children admitted to a PICU with hypoxic-ischemic coma.

PATIENTS AND METHODS: A retrospective review (1991-1996) of 24 children with hypoxic-ischemic coma admitted to the pediatric ICU of a reference hospital was performed. Clinical data on admission and results of complementary explorations (EEG and neuroimaging techniques) were collected and the findings compared according to the evolution and underlying pathophysiological mechanism.

RESULTS: Non-reactive and dilated pupils, existence of neurohypophyseal disorders and isoelectric EEGs were exclusively found in dead patients. A score of 3-4 on the Glasgow Coma Score was obtained more frequently in groups with the worse evolution (exitus and surviving with sequelae), as well as positive findings with neuroimaging techniques and the appearance of seizures, though without meaningful differences. More significant was the existence of associated problems, which was more frequent in groups with a negative evolution. The differences among the pathophysiological groups were not meaningful. Global mortality in the series studied was 41.6%, with 29.2% of the survivors having neurological sequelae and 29.2% being healthy.

CONCLUSIONS: Hypoxic-ischemic coma in children has a high mortality and morbility. The prognosis for each patient is based on the clinical facts and complementary explorations. No isolated data allows the establishment of the final outcome with certainty.