Arif Zaheer, Amir Rashid, Akmal Laeeq Chishty.
Neurological disease spectrum and associated factors for morbidity and mortality among admitted children..
Pak Paed J Jan ;33(1):24-9.

Background: Neurological diseases in children are important and frequent affections, especially in developing countries, causing significant burden of disease for the family and community. The underlying diseases in developing countries vary in incidence and severity compared to developed countries. The outcome will also differ based on early diagnosis, prompt effective therapy, rehabilitation and nursing care for the survivors. Knowledge of risk factors will predict short-term outcome like death or severe disability. Objectives: To find out the spectrum of morbidity and associated factors for mortality in children admitted with neurological diseases. Material and methods: Study Setting: Pediatric department, Postgraduate Medical Institute, Lahore General Hospital, Lahore Study Design: Descriptive study. Data Collection & Procedure: One year data (2007) was collected on all admitted cases with neurological diseases including clinical findings, investigations and neuro-imaging findings. Variables of interest were age, sex, signs and symptoms, complications, final diagnosis, outcome, and disease or condition leading to death. Morbidity and mortality was presented as proportion and percentage. Various associated factors were calculated among deaths and survivors and shown as Odds Ratio and p-values. Results: 408/6089 children (6.7%) were admitted with neurological disease. 61.7% were male and 38.3% were female. 20% patients were admitted with congenital / perinatal / developmental neurological disorders, 13.0% cases with CNS infections, 16.9% cases with neoplastic disorders of CNS, 15% cases with febrile fits, 10.7% cases with seizure disorders, and 9.8 % cases with cerebral palsy. Neoplastic CNS disorders and degenerative brain diseases carried highest case fatality rates (30.4% & 30% respectively). 26% cases of CNS infections died during hospital stay. Overall mortality was 17.6%. Presence of coma, raised intracranial pressure, status epilepticus, shock at the time of admission, hydrocephalus and age <5 year were identified as associated factors for mortality. Conclusion: Neurological diseases in children in developing countries cause significant morbidities and end up as high case fatalities. Congenital/perinatal/developmental disorders, CNS infections, neoplasia and seizure disorders constitute important diagnosis. Certain associated factors predict adverse outcome like coma, raised ICP, shock, uncontrolled fits, hydrocephalus and age <5 years. Measures like mass immunizations, antenatal, natal and postnatal care and physical / mental rehabilitation etc can reduce the burden of neurological diseases and their sequelae.

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