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[Brain death in the child. Review of 12 cases]
J L Pérez Navero1, M J Velasco Jabalquinto, C de la Torre Cecilia
1Unidad de Cuidados Intensivos Pediátricos, Hospital Regional Reina Sofia, Facultad de Medicina, Córdoba.
Insights
Diagnosing brain death in children requires careful assessment. Absence of brain radioisotopic activity is a highly specific indicator, especially in ambiguous pediatric cases.
Area of Science:
- Pediatric Neurology
- Neurocritical Care
Background:
- Diagnosing brain death in children presents unique challenges.
- Establishing irreversible cessation of all brain functions is critical for clinical management and organ donation decisions.
Purpose of the Study:
- To evaluate the utility of complementary neurodiagnostic tests in confirming brain death in pediatric patients.
- To identify the most specific diagnostic tool for brain death in children, particularly in equivocal cases.
Main Methods:
- Retrospective survey of twelve children diagnosed with brain death.
- Analysis of electroencephalogram (EEG) and evoked potentials.
- Review of brain angiogammography findings.
Main Results:
- Eight children had isoelectric EEGs and non-responsive evoked potentials.
- Five of eight children undergoing brain angiogammography showed no cerebral blood flow initially.
- Brainstem auditory evoked potentials were never positive when EEG was isoelectric, though flow was detected in two such cases.
Conclusions:
- Absence of brain radioisotopic activity appears to be the most specific method for diagnosing brain death in children.
- This finding is particularly valuable in cases with uncertain clinical or EEG findings.
Abstract:
Twelve brain death diagnosed children have been retrospectively surveyed. Their age ranged between seven months and thirteen years (mean = 5.7 years old). Etiology was as follows: eight of cranial trauma, two of ground-trapped asphyxia, one of hypernatremic dehydration ans one of subglottic laryngitis. When a brain death diagnosis was suggested, neurodiagnosis complementary tests were carried out eight cases presented an isoelectric EEG since the first recording and their evoked potentials did no reflect any response. Among the eight children to whom brain angiogammography was made, five presented no flow in the first study. Brain circulation signs were detected in two other children, disappearing subsequently. When the EEG was isoelectric, positive responses were never obtained from the brainstem. However, flow was detected in two cases. We suggest that, in doubtful cases, absence of brain radioisotopic activity is the most specific way to assess brain death in children.