Etiologies et pronostic des comas non-traumatiques de l’enfant a l’hopital universitaire de Lome

Objectif . Determiner la frequence, le profil clinique, l’etiologie et l’evolution du coma non traumatique de l’enfant de un mois a 16 ans. Methode . Tous les cas consecutifs de coma identifies dans les services de pediatrie du CHU de Lome ont fait l’objet d’une etude prospective a partir d’une fiche d’enquete preetablie. Le coma a ete evalue par les echelles classiques des stades de coma et de Blantyre. Tous les enfants admis pour coma ou devenus comateux apres l’admission ont ete examines et suivis au moins 18 mois apres leur sortie du coma. Resultats . Sur 7149 enfants admis, 387 (5,4%) dont 199 garcons (51%) et 188 filles (49%), âges pour la plupart de moins de 5 ans (70%), l’ont ete pour coma ou pour diverses affections ayant entraine un coma. En tout 72,3% des comas etaient dus a l’infection, 15% a des causes toxiques metaboliques, 3,9% a des lesions anoxo-ischemiques, 2,3% a des hemorragies et 7,2% a des causes diverses. Le paludisme grave a P. falciparum (44%) et les meningites bacteriennes (35,3%) ont domine les etiologies infectieuses. L’evolution a ete fatale pour 27,6% et favorable pour 72,3% dont 44,2% sans sequelles et 28,1% avec sequelles. Avec 74,6% de guerisons et 25,3% de letalite, le coma infectieux a eu le meme pronostic que le coma toxique metabolique (74,1% et 25,8%). L’encephalopathie anoxo-ischemique (83,33% de deces), le coma anoxo-ischemique (66,67%), l’insuffisance renale (50%) et le coma de l’enfant de moins d’un an (41,42%) ont ete les etiologies de tres forte letalite. Conclusion . L’infection s’affirme comme la principale cause des comas non traumatiques de l’enfant dans le monde et l’enfant de moins d’un an, la principale victime en milieu tropical africain. Redynamiser les programmes nationaux de vaccination et de lutte contre le paludisme et les infections respiratoires aigues pour une lutte plus soutenue contre l’infection peut reduire sensiblement la morbidite et la mortalite dues aux comas. Mots cles : Coma, epidemiologie, etiologie, evolution, infection, enfant. Aetiology and prognosis of childhood non traumatic coma in the University Hospital of Lome. Aim - To determine the incidence, aetiology and outcome of non traumatic coma (NTC) in children aged between 1 month and 16 years. Methods - All consecutive cases of NTC admitted from january to december 2006 in the University Teaching Hospital of Lome (Togo) were prospectively studied. Coma was assessed by the classic coma scale and the Blantyre coma scale. All post-neonatal children admitted with acute NTC or turned into comatose patients over a 12-month period were analysed and followed up for 18 months. Results - Out of 7149 children admitted, 387 (5,4%) cases of NTC, 199 boys and 188 girls, were recruited. 271 children (70%) were under 5 years of age. 280 cases (72,3%) were due to infection, 58 (15%) to toxic metabolic causes, 15 (3.9%) to hypoxic ischaemic insults, 9 (2.3%) to intracranial haemorrhage and 28 (7.2%) were due to miscellaneous causes. Severe malaria due to P. falciparum (44%) and bacterial meningitis (35.3%) were the predominant infectious causes. Of the 387 cases, 27.6% died, 72.3% recovered but 28.16% developed neurological sequelae and 44.2% were discharged well. Infectious coma (74.1% of recovery and 25.3% of lethality) and toxic metabolic coma (74.1% and 25.3%) had the same prognosis. Hypoxic ischaemic insults (83.3% of dead), Hypoxic ischaemic coma (66.6%), renal failure (50%) and coma of child under 5 years of age (41.4%) were causes of high mortality rate. Conclusion - It is being established that infectious diseases are the commonest overall aetiology and children less than 1 year of age the main victim of NTC in African countries. Fighting infection with the national programmes for malaria and acute respiratory infection can reduce mortality and morbidity due to childhood NTC in our country. Key words : Coma; epidemiology; aetiology; prognosis; infection; child.