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Pediatric brain death determination.

Mudit Mathur1, Stephen Ashwal2

  • 1Division of Pediatric Critical Care, Loma Linda University Children's Hospital, Loma Linda, California.

Seminars in Neurology
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Summary
This summary is machine-generated.

Determining brain death in children requires two clinical exams with apnea testing. Ancillary studies are supplementary, not replacements, for the neurological examination in pediatric brain death determination.

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Area of Science:

  • Pediatric Critical Care Medicine
  • Neurology
  • Forensic Medicine

Background:

  • Clinical guidelines for determining brain death in children were established in 1987 and revised in 2011.
  • These guidelines provide minimum standards for declaring brain death in pediatric patients.

Purpose of the Study:

  • To outline the current clinical guidelines for the determination of brain death in infants and children.
  • To clarify the role of ancillary studies in the process of declaring brain death.

Main Methods:

  • Physiologic stability and exclusion of confounders are prerequisites.
  • Two neurological examinations, including apnea testing, separated by an observation period (24 hours for neonates, 12 hours for older children).
  • Apnea testing requires specific PaCO2 levels and absence of respiratory effort.

Main Results:

  • Ancillary studies (EEG, cerebral blood flow) are not mandatory for brain death determination.
  • Ancillary studies can be used when examinations are incomplete, uncertain, affected by medication, or to shorten observation periods.
  • When ancillary studies are used, a second clinical examination and apnea test are still necessary.

Conclusions:

  • The established guidelines provide a framework for determining brain death in children.
  • Ancillary studies serve a supportive role and do not replace clinical neurological assessment.
  • Consistency with brain death findings is required even when ancillary studies are employed.