[Drowning and near-drowning in children].

Drowning and near-drowning are major causes of death and neurological damage, respectively, in children. The pathophysiological substrate consists of hypoxia, ischaemia, respiratory and metabolic acidosis and sometimes, hypothermia. Most cases involve aspiration of liquid; this leads to a persistent impairment of the gas exchange. Occurrence of arrhythmias and hypovolaemia is very likely. The main objective of treatment of the near-drowned is limiting cerebral damage. Treatment consists of resuscitation and stabilization, administration of oxygen with positive end-expiratory pressure, intravenous administration of liquids and central reheating. The prognosis depends in the first place on the duration of the submersion, which, however, is often difficult to establish. Submersion for over 5 minutes is prognostically unfavourable. In hypothermia due to submersion in ice cold water the prognostic factors are less clear--in these cases the treatment should always be continued until the core temperature is > or = 32 degrees C.