Journal
CURRENT OPINION IN CRITICAL CARE
Volume 13, Issue 2, Pages 143-152Publisher
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/MCC.0b013e32808255dc
Keywords
child; development; immature; neurotransmission; plasticity
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Purpose of review This review will update the reader on the most significant recent findings with regards to both the clinical research and basic science of pediatric traumatic brain injury. Recent findings The developing brain is not simply a smaller version of the mature brain. Studies have uncovered important distinctions of the younger brain after traumatic brain injury, including an increased propensity for apoptosis, age-dependent parameters for cerebral blood flow and metabolism, development-specific biomarkers, increased likelihood of early posttraumatic seizures, differential sensitivity to commonly used neuroactive medications and altered neuroplasticity during recovery from injury. Specifically, there is strong preclinical evidence for increased neuronal apoptosis in the developing brain being triggered by anesthetics and anticonvulsants, making it paramount that future studies more clearly delineate preferred agents and specific indications for use, incorporating long-term functional outcomes as well as short-term benefits. In addition, the young brain may actually benefit from therapeutic interventions that have been less effective following adult traumatic brain injury, such as decompressive craniectomy and hypothermia. Summary An increasing body of evidence demonstrates the importance of establishing age-dependent guidelines for physiological monitoring, pharmacological intervention, management of intracranial pressure and facilitating recovery of function.
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