Neurologic Sequelae after Childhood Near-Drowning: A Total Population Study from Hawaii

¹ Department of Child Health, Queensland, Australia, the Kauikeolani Children's Hospital, and the Tripler Army Medical Center, Honolulu

Whether or not a resuscitated child will suffer brain damage is crucial to the management of drowning and near-drowning victims. The length of time one persists with attempted resuscitation, the intensity of supportive therapy, and the prognosis one can give to parents in the hours or days after rescue, all depend on this point. With the proliferation of childhood drowning accidents¹ it is essential that the natural history of hypoxic brain damage after near-drowning be accurately documented.

Two recent large studies^2,3 have attempted to shed light on this subject, but have given diametrically opposed results. One such report, a total population study from Queensland, Australia,^1,4 has shown that the incidence of neurologic deficit after loss of consciousness in fresh water was only 5%,² although 30% of such childhood cases had an abnormal subscale scatter in formal IQ assessments. It was concluded that from the neurologic point of view, "the prognosis of near-drowning in childhood is excellent."

By contrast, a large study from California³ (published almost simultaneously with the study from Australia) found that 21% of children (72 cases) who were admitted after near-drowning were severely brain damaged. So worrying were these figures that it was concluded that before intensive hospital-based life support was commenced, consideration should be given to the significant possibility that a permanently brain-damaged child would result. It was concluded that "it is a misconception that irreversible brain damage is an uncommon complication in near drowning."

It is unlikely that water temperature differences between these two centers would explain this diversity (ranges of water temperatures were not given in either report).