Cardiovascular events in children with brain injury: A systematic review
Marta João Silva1, Bárbara Carneiro2, Ricardo Mota3
1Faculty of Medicine of University of Porto, Porto, Portugal; Pediatric Intensive Care Unit, Centro Hospitalar Universitário de São João, Porto, Portugal.
Insights
Pediatric brain injury can cause heart problems like neurogenic stunned cardiomyopathy. Early cardiac evaluation is crucial for identifying poor prognostic factors and improving outcomes in children.
Area of Science:
- Pediatric neurology
- Cardiology
- Critical care medicine
Background:
- Brain injury is a significant cause of death and disability in children.
- Neurogenic stunned cardiomyopathy, a complication of neurological conditions, worsens patient outcomes.
- This condition involves blood pressure changes, cardiac arrhythmias, and elevated cardiac injury biomarkers.
Approach:
- A systematic review was conducted using literature searches in PubMed, Scopus, and Web of Science.
- The search included studies published up to October 3rd, 2022.
- Quality assessment of selected articles was performed using National Heart, Lung, and Blood Institute tools.
Key Points:
- Thirteen articles were reviewed, focusing on arterial pressure, rhythm disturbances, and myocardial injury biomarkers post-brain injury.
- Both hypotension and hypertension are linked to adverse outcomes in pediatric brain injury.
- Brain injury may correlate with prolonged QTc intervals, and neurogenic stunned cardiomyopathy is frequently observed.
Conclusions:
- This review highlights cardiovascular abnormalities following pediatric brain injury.
- Early assessment of arterial pressure, ECG, echocardiography, and cardiac biomarkers is vital for prognosis.
- Further research is needed to translate these findings into clinical practice.
Background:
Brain injury is a leading cause of morbidity and mortality in the pediatric population. Neurogenic stunned cardiomyopathy is a complication associated with several neurological conditions that can lead to worse outcomes. It presents as alterations in blood pressure, cardiac rhythm disturbances and the increase in cardiac injury biomarkers. This systematic review aims to assess the hemodynamic consequences of brain injury in the pediatric population to identify better management strategies and improve outcomes.
Methods:
An electronic literature search was performed in Pubmed, Scopus and WebOfScience, up until October 3rd, 2022. The selected articles underwent quality assessment using the National Heart, Lung and Blood Institute tools for cohort and case-control studies.
Results:
This systematic review includes thirteen articles on the effects of brain injury in arterial pressure, rhythm disturbances and biomarkers of myocardial injury. These studies showed the following key results: both hypotension and hypertension are associated with worse outcomes; brain injury could be related to longer QTc intervals; neurogenic stunned cardiomyopathy was a common found after brain injury.
Conclusion:
This is the first systematic review to report cardiovascular abnormalities arising from brain injury in children. An early arterial pressure, electrocardiographic and echocardiographic evaluation, as well as the measure of serum biomarkers for myocardial injury, can be critical in identifying poor prognostic factors. Further research is required to understand the implications of our findings in clinical practice.
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