Age-Specific Characteristics of Brain Death in Children

Clinical course and determination of brainstem death in a children's hospital

“…We also showed that observation of the young brainstem-dead child aged between 2 and 12 mo beyond the accepted 12-h period did not provide any diagnostic advantage. Four children observed between 24 to 69 h had no return of neurologic function, similar to other reported studies of brain death in young children (18,19). This is in agreement with the RCPCH guidelines, which make no distinction between infants >2 mo of age and older children as compared to the American guidelines, which necessitate a lengthier period of observation in infants.…”

Brain Death in Children: Incidence, Donation Rates, and the Occurrence of Central Diabetes Insipidus

“…The five studies that have published exclusively on pediatric patients, collectively indicated that 145 (52%) of 279 patients had CDI [ 3,4,9,16,17]. The data of the current study suggest that the prevalence of CDI in our pediatric BD population is higher (89%) than other reports in literature.…”

Ancillary investigations for death determination in infants and children: a systematic review and meta-analysis

“… 40 Seven studies included patients with confirmed DNC. 32 , 36 , 40 , 41 , 44 , 52 , 53 In patients with suspected DNC, pooled analysis showed a sensitivity of 0.88 (95% HDI, 0.78 to 0.96) and a specificity of 0.96 (95% HDI, 0.82 to 1.00). The certainty of evidence is very low for both sensitivity and specificity because of serious risk of bias, indirectness, and imprecision (ESM eTable 4).…”

“…A second study had 28 patients who underwent either four-vessel cerebral angiography or an unspecified radionuclide scan following clinical exam consistent with DNC. 44 No cerebral blood flow was present for any patients with suspected DNC ( n = 28); however, given the investigations were not stratified per patient, we were unable to use the data in the four-vessel cerebral angiography analysis. Unfortunately, no pediatric or adult studies included patients without DNC, so no data exist from which to calculate specificity.…”

“…We identified 13 studies ( n = 299) that evaluated EEG as an ancillary investigation for DNC. 20 , 24 , 26 , 32 , 34 – 36 , 40 , 41 , 44 , 51 – 53 Thirteen patients studied had known confounders including detectable phenobarbital levels ( n = 11), 34 , 41 , 44 or hypothermia and a detectable phenobarbital level ( n = 2) 35 at the time of EEG. Typical studies defined an EEG with electrocerebral silence as consistent with DNC, one stated an isoelectric EEG was consistent and another defined a “flat” EEG as consistent with DNC.…”