All issues > Volume 43(6); 2000

Original Article

J Korean Pediatr Soc. 2000;43(6):814-819. Published online June 15, 2000.

Hemorrhagic Shock and Encephalopathy Syndrome as a Cause of Sudden Death in Infants

Jong Won JW Lee¹, Chang Han CH Lee¹, Ki Sup KS Chung¹

¹Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea

Abstract

Purpose
: To evaluate the clinical characteristics, treatments and outcome of patients with hemorrhagic shock and encephalopathy(HSE) syndrome.
Methods
: We performed a clinical study on 14 patients who were diagnosed as hemorrhagic shock and having encephalopathy syndrome in the Department of Pediatrics, from 1984 to 1998. Age, sex, clinical symptoms and physical findings at admission, the most deranged laboratory findings, radiologic findings, treatments and outcome were analyzed.
Results
: The age of onset was 1.0±0.9 years and the male to female ratio was 1 : 1.8. At admission, clinical findings included dehydration in 85.7%, shock in 85.7%, fever in 71.4%, vomiting in 71.4%, diarrhea in 64.3%, GI bleeding in 50%, convulsion in 42.9%, and edema in 35.7%. Altered mental state was found in 100%, hepatomegaly in 64.3%, and splenomegaly in 21.4%. Laboratory findings revealed D-dimer positive in 92.9%, the mean hemoglobin level 8.2±2.1g/dL, BUN 35.7±24.0mg/dL, creatinine 1.9±1.5mg/dL, AST 561.0±1,412.1IU/L, ALT 858.9±1,649.8IU/L, blood glucose 229.5±197.4mg/dL, ammonia 195.4±129.7μg/dL, and total bilirubin 4.9±8.2mg/dL. On serologic tests, rotavirus and Epstein-Barr virus was found in 1 patient(7.1%), respectively. The mortality rate was 78.6%.
Conclusion
: We found that shock and disseminated intravascular coagulation(DIC) played important roles in the pathogensis of HSE syndrome, and encephalopathy, hepatic and renal insufficiency, and respiratory failure were secondary complications resulting from shock and DIC. Despite vigorous treatment, the prognosis was very poor. We feel more efforts should be focused on investigating the etiology and pathophysiology of HSE to prevent as well as develop a specific therapy.

Keywords :Hemorrhagic shock and encephalopathy(HSE) syndrome, Disseminated intravascular coagulation, Rotavirus, Infancy, Sudden death