Acute neurologic clinical manifestations and outcomes in children with thrombotic microangiopathies in paediatric intensive care units.
Nearly one-third of children with thrombotic microangiopathies develop neurological complications in intensive care.
Acute neurologic clinical manifestations and outcomes in children with thrombotic microangiopathies in paediatric intensive care units.
UNLABELLED: Neurological involvement is rare in paediatric thrombotic microangiopathies (thrombotic microangiopathies), with scarce information to guide clinical management.
Therefore, this study aimed to describe and compare the characteristics, risk factors, and outcomes between children with and without severe neurological involvement in the context of thrombotic microangiopathies requiring intensive care.
We included 160 patients (50.6% female) with a median age of 2.8 years (interquartile range [IQR], 1.6-6).
Almost 3 in 10 children with this condition developed neurological problems, most severe, during ICU stay.
This was a prospective multicentre observational study in 20 paediatric intensive care units (paediatric intensive care units) in Spain, the MATUCIP Registry, from January 2017 to December 2025 including children aged more than 1 month with thrombotic microangiopathies, who were followed up through discharge from the paediatric intensive care units.
The main outcome was the incidence of severe neurological involvement, and secondary ones were its relation with supportive care, length of paediatric intensive care units stay, and laboratory findings.
At baseline, 121/160 presented with gastrointestinal (75.6%), 22/160 respiratory (13.8%), manifestations.
In our cohort, almost one-third of participants developed neurological manifestations, most of them severe, during a paediatric intensive care units admission for thrombotic microangiopathies, and this was associated with prolonged recovery times and an increased need for supportive interventions.
This warrants close neurological surveillance by paediatric intensive care units staff for the timely introduction of protective measures, although the impact of such measures on mortality and long-term outcomes needs further research.