Proceedings of the First Pediatric Coma and Disorders of Consciousness Symposium by the Curing Coma Campaign, Pediatric Neurocritical Care Research Group, and NINDS: Gearing for Success in Coma Advancements for Children and Neonates

Abstract

This proceedings article presents the scope of pediatric coma and disorders of consciousness based on presentations and discussions at the First Pediatric Disorders of Consciousness Care and Research symposium held on September 14th, 2021. Herein we review the current state of pediatric coma care and research opportunities as well as shared experiences from seasoned researchers and clinicians. Salient current challenges and opportunities in pediatric and neonatal coma care and research were identified through the contributions of the presenters, who were Jose I.

Update in Pediatric Neurocritical Care: What a Neurologist Caring for Critically Ill Children Needs to Know

“…303,305 There is a need for pediatric-specific tools, especially for children younger than 4 years in whom language-based skills are less applicable. 303,306 Recent advances have enabled the recognition of states of covert consciousness, including cognitive motor dissociation (CMD), in which task-based fMRI or EEG data detect volitional brain activity in a patient without command following on clinical exam. Adult studies suggest that the prevalence of CMD may be as high as 15 to 20% of patients with DoC, and its detection has prognostic importance.…”

Functional MRI for Acute Covert Consciousness: Emerging Data and Implementation Case Series

“…1 Even more importantly, the detection of brain activity indicating potential for good outcome may lead to the development of targeted therapies, such as pharmacologic agents, brain stimulation, and brain–computer interfaces. 15 18 35 36 37 38…”

“…1 Even more importantly, the detection of brain activity indicating potential for good outcome may lead to the development of targeted therapies, such as pharmacologic agents, brain stimulation, and braincomputer interfaces. 15,18,[35][36][37][38] After ABI, having some degree of consciousness, yet appearing to be in a coma or have unresponsive wakefulness syndrome (UWS), is possible. 30 If such patients can follow a command as shown by advanced testing, then their degree of consciousness meets criteria for covert consciousness or cognitive motor dissociation (CMD; ►Fig.…”

Beyond Survival: Insights From the Phenotyping Sepsis-Induced Multiple Organ Failure Study on the Neurological Impact of Pediatric Sepsis*

“…Campaign" launched by the Neurocritical Care Society in 2020 has sparked growing interest in studying coma in ICUs (1). Disorder of consciousness refers to a state between full consciousness and coma (2)(3)(4). Philosophically, consciousness can be defined as wakefulness, sentience, and self-consciousness.…”

“…Since that time, our understanding of the metabolic response has evolved. Brain injury can induce activation and dysregulation of metabolic, inflammatory, and neuroendocrine systems (2). The modern approach to therapy in children with TBI is aimed at decreasing metabolic demand and preventing cerebral hypoperfusion to limit secondary brain injury (3).…”