NEUROLOGIC OUTCOMES IN CHILDREN WITH ENTEROVIRUS 71-RELATED CARDIOPULMONARY FAILURE AFTER EXTRACORPOREAL MEMBRANE OXYGENATION: PROGNOSTIC VALUE OF SERUM NEURON SPECIFIC ENOLASE

Objectives: There is a high fatality and morbidity rate of enterovirus 71 (EV71) infection. Extracorporeal membrane oxygenation (ECMO) could be a life saving facility in such patients; however, it takes the risk of cerebrovascular complications. We conduct this study to test the correlation of serum neuron specific enolase (sNSE) value and neurological outcomes in children with severe cardiorespiratory failure with ECMO treatment.

Methods: From June 2005 to July 2005, a prospective study in the pediatric intensive care unit of Chang Gung Children's Hospital, three children (ages 7 to 63 months) with EV71 infection complicated with cardiopulmonary failure were enrolled. The clinical characteristics were systemically assessed. sNSE was checked 24 hr, 48 hr and 168 hr after ECMO treatment. EEG was performed in each patient. Brain MRI was followed after removal of ECMO.

Results: Of the 3 patients, 1 died, 1 survival with minor neurologic sequelae and 1 with ventilatordependent. sNSE is higher in the child of mortality. EEG was normal in the child with minor sequelae but slow waves and epileptiform activity in the other 2. Brain MRI revealed brainstem lesions in all 3 children. Global hypoxia-ischemic encephalopathy was noted in the child of mortality.

Conclusion: sNSE could be a predictor for the neurologic outcome in children with EV71-related cardiopulmonary failure after ECMO. The results are promising and justify more data with sNSE in larger numbers of children with EV71 infection.