Metabolic Response of Pediatric Traumatic Brain Injury

Prins, Mayumi L.; Matsumoto, Joyce H.

doi:10.1177/0883073814549244

Cited by 17 publications

(6 citation statements)

References 89 publications

(104 reference statements)

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“…6 Early postinjury impact has not been well studied; however, it is generally accepted that there is an initial acute hypermetabolic response and increase in energy needs. [7][8][9][10] During recovery, metabolism may increase to account for increased physical activity, healing, and weight restoration. 11 The described metabolic changes throughout recovery from a TBI can complicate feeding the patient.…”

Section: Metabolic Response To a Tbimentioning

confidence: 99%

“…Other stress responses and treatments may also impact energy metabolism, such as an increase in calorie needs caused by poor temperature control or a decrease in the setting of mechanical ventilation and/or sedation 6 . Early postinjury impact has not been well studied; however, it is generally accepted that there is an initial acute hypermetabolic response and increase in energy needs 7–10 . During recovery, metabolism may increase to account for increased physical activity, healing, and weight restoration 11 .…”

Section: Introductionmentioning

confidence: 99%

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Variation in metabolic demand following severe pediatric traumatic brain injury: A case review

Wallinga,

Newkirk,

Gardner

et al. 2023

Nut in Clin Prac

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A traumatic brain injury (TBI) is one of the most common pediatric traumas among children in the United States. Appropriate nutrition support, including the initiation of early enteral nutrition, within the first 48 h after injury is crucial for children with a TBI. It is important that clinicians avoid both underfeeding and overfeeding, as both can lead to poor outcomes. However, the variable metabolic response to a TBI can make determining appropriate nutrition support difficult. Because of the dynamic metabolic demand, indirect calorimetry (IC) is recommended, instead of predictive equations, to measure energy requirements. Although IC is suggested and ideal, few hospitals have the technology available. This case review discusses the variable metabolic response, identified using IC, in a child with a severe TBI. The case report highlights the ability of the team to meet measured energy requirements early, even in the setting of fluid overload. It also highlights the presumed positive impact of early and appropriate nutrition provision on the patient's clinical and functional recovery. Further research is needed to investigate the metabolic response to TBIs in children and the impact optimal feedings based on the measured resting energy expenditure have on clinical, functional, and rehabilitation outcomes.

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Section: Metabolic Response To a Tbimentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Variation in metabolic demand following severe pediatric traumatic brain injury: A case review

Wallinga,

Newkirk,

Gardner

et al. 2023

Nut in Clin Prac

View full text Add to dashboard Cite

show abstract

“…50 These studies raise the possibility that dietary approaches could have therapeutic benefit for posttraumatic headache (although there is currently no evidence to support this possibility). Preclinical models of mild to severe traumatic brain injury have demonstrated improved outcomes with pre and post injury administration of the ketogenic diet.…”

Section: Basic Mechanisms Of Pth As Targets For Therapymentioning

confidence: 99%

“…Preclinical models of mild to severe traumatic brain injury have demonstrated improved outcomes with pre and post injury administration of the ketogenic diet. 50 These studies raise the possibility that dietary approaches could have therapeutic benefit for posttraumatic headache (although there is currently no evidence to support this possibility). Exogenous creatine supplementation is another possible therapy that may be worthy of further study.…”

Section: Basic Mechanisms Of Pth As Targets For Therapymentioning

confidence: 99%

Posttraumatic Headache: Basic Mechanisms and Therapeutic Targets

Kamins

Charles²

2018

Headache

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Frequent or continuous headache, often refractory to medical therapy, is a common occurrence after head trauma. In addition to being the most common acute symptom after traumatic brain injury (TBI), headache is also one of the most persistent and disabling symptoms. Different studies indicate that 18-58% of those suffering a TBI will have significant headache at 1 year following the trauma. In addition to being disabling on its own, posttraumatic headache (PTH) is a predictor of overall outcome after concussion. Despite its remarkable prevalence and associated social and economic costs, many fundamental and important questions about PTH remain unanswered. The purpose of this review is to identify key questions regarding the clinical characteristics of posttraumatic headache, its basic mechanisms, and its optimal management. We discuss phenotypic features of PTH, pathophysiological mechanisms of TBI including potential overlaps with those of migraine and other primary headache disorders, and potential novel targets for treatment. We suggest different strategies to finding answers to the questions regarding PTH in order to advance the understanding of the disorder and develop more effective therapies.

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“…A common misconception is that children with brain injury fare better than adults [19]. However, the pathology differs from adults, because in infants and children injury is superimposed on the highly orchestrated processes and high metabolic demands of the developing brain [19–25]. Acute injury in the pediatric brain can derail or even halt normal developmental processes due to energy failure, disrupted cell division and synaptogenesis, impaired ionic gradients and depleted antioxidant capacity which can further impair metabolism [26–30].…”

Section: Developmental Brain Injuries That Can Lead To Poor Neurodevementioning

confidence: 99%

Metabolic Alterations in Developing Brain After Injury: Knowns and Unknowns

2015

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Brain development is a highly orchestrated complex process. The developing brain utilizes many substrates including glucose, ketone bodies, lactate, fatty acids and amino acids for energy, cell division and the biosynthesis of nucleotides, proteins and lipids. Metabolism is crucial to provide energy for all cellular processes required for brain development and function including ATP formation, synaptogenesis, synthesis, release and uptake of neurotransmitters, maintaining ionic gradients and redox status, and myelination. The rapidly growing population of infants and children with neurodevelopmental and cognitive impairments and life-long disability resulting from developmental brain injury is a significant public health concern. Brain injury in infants and children can have devastating effects because the injury is superimposed on the high metabolic demands of the developing brain. Acute injury in the pediatric brain can derail, halt or lead to dysregulation of the complex and highly regulated normal developmental processes. This paper provides a brief review of metabolism in developing brain and alterations found clinically and in animal models of developmental brain injury. The metabolic changes observed in three major categories of injury that can result in life-long cognitive and neurological disabilities, including neonatal hypoxia-ischemia, pediatric traumatic brain injury, and brain injury secondary to prematurity are reviewed.

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Metabolic Response of Pediatric Traumatic Brain Injury

Cited by 17 publications

References 89 publications

Variation in metabolic demand following severe pediatric traumatic brain injury: A case review

Variation in metabolic demand following severe pediatric traumatic brain injury: A case review

Posttraumatic Headache: Basic Mechanisms and Therapeutic Targets

Metabolic Alterations in Developing Brain After Injury: Knowns and Unknowns

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