Discussion
sequalae, encephalitis, neurodisability, functional impairments, impairment of gross motor function, disability
ENCEPHALITIS, MINOR, RECRUITMENT
The IgNiTE study was terminated early due to slower than expected recruitment and was therefore unable to provide conclusive evidence regarding the efficacy of IVIG in the treatment of childhood encephalitis. Thus, it remains unknown whether early administration of IVIG in children with all-cause encephalitis offers clinical benefit.While the IgNITE study was unable to address the primary study objective, the results do provide evidence of the poor outcomes experiences by many children with encephalitis. Almost a third of participants made a poor recovery based on GOS-E Peds assessment at 12 months after randomisation. Other measures of neurological outcomes consistently demonstrated a heavy burden of disability; 44% of patients had minor to severe sequalae at 12 months according to the LOS assessment, and the same proportion of patients experienced mild or severe impairment of gross motor function at the same timepoint. The proportion of children with functional impairments on the SDQ and ABAS-II assessments at 12 months after randomisation was lower, but this was likely due to fewer participants completing these assessments.The results also demonstrate the impact of childhood encephalitis on healthcare systems. Over half of participants required admission to intensive care during the acute illness, and 90% of these children were intubated. The overall median length of acute hospital care for participants was 11 days, compared with a mean length of hospital stay of 1.64 days for children and young people following an emergency admission in the UK.These data are consistent with previous studies of childhood encephalitis in high-income settings. In a prospective Australian study involving 287 children with encephalitis, 49% of children required admission to intensive care, median length of hospitalisation was 11 days and 27% of children had moderate to severe neurodisability at hospital discharge.