Critical illness neuropathy in pediatric intensive care patients

Critical illness neuropathy is an axonal polyneuropathy recognized more fre quently in adult intensive care patients with sepsis and multiple organ dys function, In children the diagnosis is rarely made. Within 1 year the autho rs observed two children with critical illness neuropathy, Both patients, a male 6 years, 6 months of age with a brain contusion and a male 2 years, 6 months of age who underwent craniectomy for Crouzon's disease, required pr olonged mechanical ventilation and developed sepsis with multiple organ dys function. Three to 4 weeks after successful treatment of the sepsis, a flac cid tetraparesis was noticed in both patients. Laboratory investigations of blood and cerebrospinal fluid and spinal magnetic resonance imaging reveal ed normal results. Electrophysiologic examinations were indicative of an ax onal polyneuropathy, Spontaneous improvement occurred within several months . It is likely that critical illness neuropathy occurs more often in critic ally ill children than previously thought. Careful neurologic examination a nd early electrophysiologic investigations are necessary to establish the d iagnosis. Important differential diagnoses of acquired lower motor neuron w eakness in pediatric intensive care medicine are discussed. (C) 1999 by Els evier Science Inc. All rights reserved.