الفهرس 
Patients and methodsOnly 14 pages are availabe for public view
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Abstract
Advances in medical and surgical care for children in the pediatric intensive care unit (PICU) have led to vast reductions in mortality, but survivors often leave with newly acquired or worsened morbidity. Emerging evidence reveals that survivors of pediatric critical illness may experience a constellation of physical, emotional, cognitive, and social impairments, collectively known as the “post-intensive care syndrome in pediatrics” (PICs-P).
The Functional Status Scale (FSS) was developed based on the concepts of Daily Life Activities (DLA) and adaptive behavior. This scale evaluates the functional score in motor and cognitive domains specifically developed for hospitalized pediatric patients. It is a quantitative, fast and reliable method, independent of subjective assessments, applicable to a wide age range, from term newborns to adolescents, and is described as the most complete instrument for the evaluation of these patients .
This study aimed to study different clinico-investigative profile of neurological disorders in pediatric intensive care units and to evaluate functioning outcome of survivors by functional status scale (FSS).
This study was conducted on 194 children, who were admitted to pediatric intensive care unit (PICU) of pediatrics department of Benha University hospital and Shebin El-Kom Teaching hospital, during the period from March 2018 to April 2019.
Statistical analysis shows that:
• This study included 101 males and 93 females; their mean age was ranged 1.5-3.6 years.
Status epilepticus was the most common cause of PICU admission (30.9%), followed by CNS infection and inflammation (28.6%), then post anoxic brain injury (18.6%).
Thirty four percent of children had developmental delay, 44% had history of NICU admission, 17% had history of previous PICU admission, and 18% of children had congenital anomalies. Regarding chronic comorbidities; 40% of children didn’t have a known comorbidity, 20% of children were known epileptic, and 9.2% had cerebral palsy.
Forty three point eight percent of cases had convulsions, 72.7% had DCL, and 15.5% had paralysis or paresis. Most cases (58%, 59%) had normal tone and reflexes, 28%, 33% had hypotonia and hyporeflexia, and 14% had hypertonia and 8% hyperreflexia. 73.2% had normal and reactive pupils. The median GCS was 13(ranged; 11-15), the median PRISM score was 7 (ranged; 6-10), and the median baseline FSS score was 6 (ranged; 6-8).
•CT brain examination was done in 59% of cases, 25% of cases had normal CT, 13% had brain edema, 11% had brain atrophy, 6% had hemorrhage, 3% had infarction. MRI brain was done in 45 children (23%), 17 of them was normal, 10 patients had encephalomalecia, 3% had sagittal sinus thrombosis,2% had ADEM, 2% had herpetic encephalitis, and 3% had infarction. Regarding EEG; 14% of children had epileptic focus, regarding lumbar puncture; 13.6% of children had epileptic focus, regarding lumbar puncture; 10%of patients had Bacterial meningitis, 4% had viral encephalitis, 2% had acute disseminated encephalomyelitis and 35% of cases had normal CSF examination.
Lines of treatment of the studied group antibiotic were given to 97% of patients, corticosteroids were prescribed in 33%, Hemodynamic intervention were used in 27%,Central venous line was used 41%, intubation was done to 49%, Critical care intervention to 62% and ventilator support were used in 31% of children
•The mean length of hospital stay was 5 (ranged 4-7) days, the mortality rate was 9.3%, and 29 % of children acquire new comorbidity and 15.5% needed rehabilitation after discharge.
The mean FSS on discharge was 8(6-9). FSS was normal (6) in 61.3% of patients and increased (range; 7-10) in 29% of patients. Feeding domain was the most affected 2(1-3), followed by motor 1(1-3) and communication domains 1(1-2).
FSS score differs significantly between patients according to their cause of admission being higher in cases with CNS infection.
FSS score differs significantly between patients according to their CT brain, MRI brain and LP, being higher in cases of abnormal results. While there was no significant difference in FSS score regarding results of EEG.
FSS score differs significantly between patients according to medical treatment, patients who received corticosteroid, inotropes and who required ventilator support had higher FSS score compared to other patients.
FSS score at discharge correlated positively with WBCs, PRISM score, FSS on admission, duration of MV and LOS, and correlated negatively with platelets and GCS while there was no significant correlation between FSS score, and other parameters.
LOS correlated positively with ALT, AST, PRISM score, FSS on admission and duration of MV and correlated negatively with age, hemoglobin and platelets.
Out of the 57 patients with acquired morbidity at PICU discharge, 10 (18 %) recovered functional status before hospital discharge there were 10 losses follow ups (3 died.7 had lost follow ups) ,126 (76%) recovered baseline FSS score in the three-month follow-ups, and also 132 (80%)in the six-month follow-up put not reach number of cases 161 (83%) (Admission) baseline FSS score.