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Updated: May 22, 2026
Assessing Changes in Synaptic Plasticity Using an Awake Closed-Head Injury Model of Mild Traumatic Brain Injury
Published on: January 20, 2023
Traumatic brain injury in infants and toddlers, 0-3 years old
A V Ciurea1, M R Gorgan, A Tascu
1Bagdasar Arseni Clinical Emergency Hospital, Department of Neurosurgery, Bucharest, Romania. rsn@bagdasar-arseni.ro
Insights
Pediatric traumatic brain injuries in children aged 0-3 years exhibit unique neurotraumatic pathology. Early diagnosis and specialized pediatric neurosurgical care are crucial for improving outcomes in these young patients.
Area of Science:
- Neurology
- Pediatric Neurosurgery
- Traumatology
Background:
- Children aged 0-3 years possess distinct anatomical and pathophysiological features influencing neurotraumatic injury patterns.
- Understanding these age-specific characteristics is vital for accurate diagnosis and management of traumatic brain injuries in infants and toddlers.
Observation:
- This study analyzed 10 years of data on traumatic brain injuries in children aged 0-3 years, excluding polytrauma cases.
- Common injuries included diastatic skull fractures, depressed skull fractures, cephalhematomas, and extradural hematomas.
- Clinical presentations often involved seizures, pallor, and rapid loss of consciousness, with cerebral CT-scan as the primary diagnostic tool.
Findings:
- Diastatic skull fractures were most common (72 cases), followed by depressed skull fractures (61 cases).
- Severe brain injury with diffuse ischemia ('black-brain') had a universally poor outcome.
- Cerebral MRI was used for follow-up, and seizure prevention was highlighted as important.
Implications:
- Infants and toddlers with head injuries require specialized pediatric neurosurgery and intensive care.
- Prompt and appropriate management, alongside preventative strategies, can significantly improve outcomes for pediatric traumatic brain injuries.
- Recognizing the unique neurotraumatic pathology in this age group is essential for effective clinical practice.
Object:
Children 0-3 years old present a completely different neurotraumatic pathology. The growing and the development processes in this age group imply specific anatomical and pathophysiological features of the skull, subarachnoid space, CSF flow, and brain. Most common specific neurotraumatic entities in children 0-3 years old are cephalhematoma, subaponeurotic (subgaleal) hematoma, diastatic skull fracture, grow skull fracture, depressed ('ping-pong') skull fracture, and extradural hematoma.
Methods:
We present our 10 years experience in neuropediatric traumatic brain injuries, between 1999 and 2009, in the First Department of Neurosurgery and Pediatric Intensive Care Unit. Including criteria were children, 0-3 years old, presenting only traumatic brain injury. We excluded patients with politrauma, who require a different management.
Results:
We present the incidence of these specific head injuries, clinical and imagistic features, treatment, and outcome. We found 72 children with diastatic skull fracture, 61 cases with depressed ('ping-pong') skull fracture, 22 cases with grow skull fracture, 11 children harboring intrusive skull fracture, 58 cephalhematomas, 26 extradural hematomas, and 7 children with severe brain injury and major posttraumatic diffuse ischemia ('black-brain'). Usually, infants and toddlers present with seizures, pallor, and rapid loss of consciousness. First choice examination, in all children was cerebral CT-scan, and for follow-up, we performed cerebral MRI. We emphasize on the importance of seizure prevention in this age group. Children presenting with extensive diffuse ischemia ('black-brain') had a poor outcome, death occurring in all 7 cases.
Conclusion:
Children 0-3 years old, present with a total distinctive pathology than adults. Children with head injury must be addressed to a pediatric department of neurosurgery and pediatric intensive care unit. Prophylaxis pays the most important role in improving the outcome.
