1139 QUALITY OF LIFE AFTER PROLONGED NON-TRAUMATIC COMA IN CHILDREN: A REAPPRAISAL

Abstract

Recent advances in medical technology have resulted in a reduced mortality of critically ill children, but quality of life in these survivors remains ill-defined. Such information is of particular importance in an era when physicians are frequently called upon to decide whether and when to discontinue extraordinary measures of life support. We report the outcome (follow-up 1-7 yrs) in 16 children ages 6 mos-16 yrs in coma of non-traumatic origin for longer than 5 days. The 8 girls and 8 boys remained in coma for periods of 6-180 days (median 17.5 days) and 12 children remained in deep coma 1-35 days (median 10.9 days). Major neurological residua (seizures, developmental retardation, blindness) occurred in 4, minor residua (MBD, minimal motor deficits, personality disorder) in 7, and no deficits were observed in 5 children. After recovery 6 were average or superior in intelligence and 2 additional children exhibited no decrement in I.Q. The liklihood of sequelae appeared related to etiology and occurred in all cases of anoxia (5/5), frequently after encephalitis (5/8) but in none of the children with Reye Syndrome (0/3) Duration of deep coma as well as the presence of increased intracranial pressure for more than 2 days appeared to influence outcome. However seizures, the necessity of assisted ventilation, or the duration of light coma was not of any predictive value. Our results suggest that a significant proportion of children surviving prolonged coma of non-traumatic origin are able to attain a meaningful quality of life.

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