What is the treatment and prevention of Reyes syndrome in children and teenagers?

Treatment and Prevention of Reye Syndrome in Children and Teenagers

The most effective strategy for preventing Reye syndrome is to avoid aspirin use in children and teenagers, particularly during viral illnesses such as influenza and varicella (chickenpox). 1, 2, 3

Understanding Reye Syndrome

Reye syndrome is a rare but potentially fatal condition characterized by:

• Acute encephalopathy
• Hepatic dysfunction
• Typically occurs following a viral illness (especially influenza or varicella)
• Presents 3-5 days after the viral prodrome when the child appears to be recovering
• Manifests with protracted vomiting and neurological changes

Prevention Strategies

Primary Prevention

• Avoid aspirin use in children and teenagers 1, 4

  • FDA requires warning labels on all aspirin products
  • Particularly important during viral illnesses
  • Use alternative antipyretics/analgesics (acetaminophen) instead

• Vaccination

  • Annual influenza vaccination for children ≥6 months 3
  • Varicella vaccination 2
  • Vaccinate family members to reduce transmission risk 3

For Children Requiring Antiplatelet Therapy

• During viral illnesses:

  • Temporarily discontinue aspirin during suspected influenza or varicella infections 2
  • Use acetaminophen for fever management 3
  • Consider alternative antiplatelet agents when necessary

• Alternative antiplatelet options:

  • Clopidogrel (1 mg/kg/day, up to 75 mg) for patients with aspirin allergy 3

Treatment Approach

There is no specific treatment for Reye syndrome once it develops. Management focuses on supportive care:

1. Early recognition is critical

   • Unexpected vomiting and disturbed brain function following viral illness
   • In infants: symptoms may include diarrhea, respiratory disturbances, and seizures 5

2. Hospital admission and intensive care

   • Continuous monitoring of vital signs and neurological status
   • Management of cerebral edema
   • Hypertonic glucose infusion
   • Intermittent hypertonic mannitol infusion 6

3. Supportive measures

   • Correction of metabolic abnormalities
   • Maintenance of fluid and electrolyte balance
   • Respiratory support as needed
   • Prevention of secondary complications

Risk Factors and Cautions

• Highest risk situations:

  • Children and teenagers with viral illnesses (especially influenza and chickenpox)
  • Self-medication with aspirin by older adolescents 5
  • Use of aspirin-containing medications for fever control

• Special considerations:

  • Recurrent episodes warrant investigation for inborn errors of metabolism 6
  • Mortality rate is approximately 30-40% from brainstem dysfunction 7
  • The disease involves a generalized disturbance in mitochondrial metabolism

Clinical Pearls

• The dramatic decline in Reye syndrome cases correlates with decreased aspirin use in children and increased public awareness 8
• No dose of aspirin can be considered safe in the presence of viral infection in susceptible individuals 8
• Aspirin appears to act as a co-factor in susceptible individuals, affecting mitochondrial enzyme function 8
• Early diagnosis and intervention significantly improve outcomes, reducing mortality from nearly 100% to 10-15% 6