Serial blood glucose levels and cerebral blood flow within 48 hours of admission were correlated with the clinical courses of 20 children with severe near-drowning in the Division of Child Neurology, the Department of Pediatrics, and Section of Neuroradiology, Loma Linda University School of Medicine, Loma Linda, CA. Seven children died, nine were in the persistent vegetative state, and four were normal. Ages ranged from nine month to ten years. Blood glucose levels on admission in the patients who died (511 ± 110 mg%) or who survived in a persistent vegetative state (465 ± 104 mg%) were significantly elevated compared with children who were normal at follow-up (238 ± 170 mg%). The blood glucose values returned to normal by day three of hospitalization. Cerebral blood flow measured by stable xenon computed tomography was significantly decreased in patients who died compared with those who were normal or in a persistent vegetative state. An increase in intracranial pressure was correlated with decreased cerebral blood flow but not with the elevated blood glucose. An elevated initial blood glucose on admission was highly predictive of patients who died or those with vegetative survival. Cerebral blood flow measurements were predictive of eventual death but did not differentiate patients who survived in a vegetative state from those who became normal. Combining blood glucose and cerebral blood flow values improved predictability of outcome in near-drowning. 
COMMENT. Cerebral blood flow and blood glucose determinations on admission are useful predictors of the outcome of children with near-drowning and like the Glascow Coma Scale, they are objective measurements of prognosis.