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Background and Aims

Coronavirus Disease 2019 (COVID-19) can cause nonpsesific neurologic sypmtoms in children such as headache, altered mental state and seizures. Direct viral invasion of the central nervous system and neuroinflammatory injury have been accused as the underlying causes of neurologic manifestations. Here we present a case series of 3 patients admitted to our pediatric intensive care unit with status epilepticus and associated later with COVID-19.

Methods

A 12 year-old male (Patient 1), 3 years old female (Patient 2) and 7 years old male (Patient 3) patients were admitted with status epilepticus. Patient 1 consulted with distribution of conscioussness and seizures, had SARS CoV-2 contact history. Patient 2 was brought to our emergency department with cardiac arrest followed by status epilepticus. She was positive for SARS CoV-2 on nasopharyngeal swab 3 months ago and had begun having seizures for two weeks. Patient 3 had hyperactivity disorder and consulted with behavioral changes and seizures. He did not have SARS CoV-2 contact history.

Results

All patients had lympopenia on admission. C-reactive protein, procalcitonin, ferritin and Pro-Brain natriuretic peptide levels were in normal ranges. D-dimer was increased in Patients 1 and 2 (7.99, 3.26µgFEU/mL, respectively). They were negative on nasopahyngeal swab for SARS CoV-2 however, Anti-SARS-CoV-2 Ig M and G were detected in their serums. Cerebrospinal Fluid work up showed high protein levels with no cell on microscopy. The patients were diagnosed with encephalitis associated with SARS CoV-2 Infection.

Conclusions

COVID-19 can cause neurologic manifestations in children and should be kept in mind especially when contact history exits.

Background and Aims

The treatment for neonatal seizures lacks a universal protocol that recommends the use of a single first-line drug. Traditionally Phenobarbital PHB has been considered the gold standard drug, however its efficacy and safety have been questioned. Levetiracetam LEV provides an alternative option with promising potential.

Aims: to systematically assess the use of LEV as the first-line anti-epileptic treatment compared to PHB. The review focused on efficacy, dosage and safety profiles of those two drugs when used to control neonatal seizures.

Methods

An online search of published literature was performed searching for trials comparing the use of LEV againstPHB. Randomised and observational studies were both included in the review.

Results

Six studies were included with a total of 420 patients; 200 in the PHB group and 220 in the LEV group. LEV was found to be non-inferior to PHB in 5 of the 6 studies, with a meta-analysis of eligible studies showing a non-significant difference [pooled odds ratio = 0.29 [0.03, 2.45], 95% CI, P = 0.26]. LEV was more likely to be associated with improved neurodevelopment assessment scores. LEV was associated with fewer adverse events, including a significantly lower risk of mortality [pooled odds ratio = 0.15 [0.02, 0.89], 95% CI, P = 0.04].

Conclusions

Our review shows that LEV can be as effective as PHB when used as first-line treatment of neonatal seizures. Moreover, it is shown to be associated with fewer adverse events and mortality. The available evidence is adequate to support the use of Levetiracetam as first-line treatment in neonatal seizures.

Background and Aims

The aim of this study is to determine the factors affecting the health related quality of life after discharge in patients admitted to PICU after TBI.

Methods

Consecutively admitted 156 pediatric patients to the PICU with TBI were included in the study. Demographic datas were scanned from electronic patient records. The PedsQL scale and GOS were evaluated by a direct phone call. The Rotterdam CT score was calculated from the radiology images.

Results

The results of 104 patients were evaluated. The total PedsQL scores were found to be statistically significantly lower in children who had severe head trauma, had multiple trauma, had intracranial bleeding in more than one area, had convulsions, had clinical signs of increased intracranial pressure. PedsQLscores were statistically significantly lower in children ≥8 years of age and followed for less than 1year. There was a negative, significant, moderate correlation between HRQL and mechanical ventilation duration, length of PICUstay and length of hospitalstay. When all statistically significant parameters were analyzed using the linear regression model, a statistically significant relationship was found between the RotterdamCTscore and the length of stay in the PICUand HRQL.

Conclusions

This study suggest that the health support provided in the first year is very important, especially for children over 8 years old. As an independent variable, it can be predicted that the HRQL may be low in children with a high Rotterdam CT score. The effect of standardized physical and psychological support programs on HRQL for patients in the risk group should be evaluated with prospective studies.