RESUMEN
OBJECTIVE: Convulsive status epilepticus can exert profound cardiovascular effects in adults including ventricular depolarization-repolarization abnormalities. Whether status epilepticus adversely affects ventricular electrical properties in children is less understood. Therefore, we sought to characterize ventricular alterations and the associated clinical factors in children following convulsive status epilepticus. METHODS: We conducted a 2-year retrospective, case-control study. Children between 1 month and 21 years of age were included if they were admitted to the pediatric intensive care unit with primary diagnosis of convulsive status epilepticus and had 12-lead electrocardiogram (ECG) within 24 hours of admission. Children with heart disease, ion channelopathy, or on vasoactive medications were excluded. Age-matched control subjects had no history of seizures or epilepsy. The primary outcome was ventricular abnormalities represented by ST segment changes, abnormal T wave, QRS axis deviation, and corrected QT (QTc) interval prolongation. The secondary outcomes included QT/RR relationship, beat-to-beat QTc interval variability, ECG interval measurement between groups, and clinical factors associated with ECG abnormalities. RESULTS: Of 317 eligible children, 59 met the inclusion criteria. History of epilepsy was present in 31 children (epileptic) and absent in 28 children (non-epileptic). Compared with the control subjects (n = 31), the status epilepticus groups were more likely to have an abnormal ECG with overall odds ratio of 3.8 and 7.0 for the non-epileptic and the epileptic groups respectively. Simple linear regression analysis demonstrated that children with epilepsy exhibited impaired dependence and adaptation of the QT interval on heart rate. Beat-to-beat QTc interval variability, a marker of ventricular repolarization instability, was increased in children with epilepsy. SIGNIFICANCE: Convulsive status epilepticus can adversely affect ventricular electrical properties and stability in children, especially those with epilepsy. These findings suggest that children with epilepsy may be particularly vulnerable to seizure-induced arrhythmias. Therefore postictal cardiac surveillance may be warranted in this population.
RESUMEN
We analyzed the growth of 12 children with tufting enteropathy for 2 years receiving total parenteral nutrition (TPN). At diagnosis, the length standard deviation score (SDS) (-2.15 ± 1.8) and body mass index (BMI) (12.6 ± 3.9) were significantly decreased. The height SDS and BMI of patients increased significantly (-1.39 ± 1.5 and 16.2 ± 1.9, respectively) after TPN. Partial catch-up growth was achieved in 7 of 12 children during the 2-year period, whereas linear growth velocity was maintained in an additional 3 patients. Insulin-like growth factor I levels correlated significantly with albumin and hemoglobin concentrations (P < 0.001), and increments in insulin-like growth factor I concentration after TPN were correlated with the changes in the BMI and height SDS (P < 001).
