Pediatric Neurocritical Care and Neurotrauma Recovery

A special issue of Children (ISSN 2227-9067). This special issue belongs to the section "Child Neurology".

Deadline for manuscript submissions: closed (31 October 2022) | Viewed by 35432

Special Issue Editors

Department of Pediatrics, Division of Critical Care, Pediatric Critical Care and Neurotrauma Recovery Program, Oregon Health & Science University, Portland, OR, USA
Interests: Pediatric Critical Care and Neurotrauma Recovery; sleep disturbances; pediatric neurocritical care
Department of Pediatrics, Division of Pediatric Psychology, Pediatric Critical Care and Neurotrauma Recovery Program, Oregon Health & Science University, Portland, OR, USA
Interests: Pediatric Critical Care and Neurotrauma Recovery; pediatric neurocritical care; outcomes after pediatric critical illness and trauma

Special Issue Information

Dear Colleagues,

The field of pediatric neurocritical care is rapidly expanding thanks to advancements in neuromonitoring, neurointervention, and neurorecovery, but more research is needed to optimize outcomes. Though mortality rates have steadily declined in pediatric critical care populations, children with acquired brain injuries from a variety of etiologies remain at high risk of mortality and long-term morbidity. Survivors experience challenges in the physical, cognitive, emotional, and social domains termed post-intensive care syndrome (PICS). Despite these risks, research in pediatrics lags behind adult populations regarding the optimal inpatient monitoring and intervention needed to improve recovery. Research on long-term outcomes is scarce for many pediatric neurocritical care diagnoses, and the use of robust outcome measurements is limited, preventing the identification of modifiable targets for intervention. Additionally, a definitive minority of pediatric survivors receive comprehensive rehabilitative care targeting PICS, hindering our understanding of outcomes across health domains after discharge. This Special Issue’s focus is on all aspects of pediatric neurocritical care from inpatient care through outpatient recovery. We particularly highlight novel and ongoing research on advanced neuromonitoring and neurorecovery in pediatric neurocritical care, seeking to improve our understanding of PICS outcomes.

Dr. Cydni Williams
Dr. Trevor Hall
Guest Editors

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Keywords

  • neurocritical care
  • pediatric
  • brain injury
  • post-intensive care syndrome
  • neuromonitoring
  • rehabilitation

Published Papers (16 papers)

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Research

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10 pages, 251 KiB  
Article
Clinical and Demographic Factors Associated with Receiving an Opioid Prescription following Admission to the Pediatric Intensive Care Unit
by Amy L. Holley, Trevor A. Hall, Ben Orwoll, Anna C. Wilson, Eleanor A. J. Battison, Denae Clohessy and Cydni N. Williams
Children 2022, 9(12), 1909; https://0-doi-org.brum.beds.ac.uk/10.3390/children9121909 - 06 Dec 2022
Cited by 1 | Viewed by 1002
Abstract
Opioids are commonly used to treat pain in the pediatric intensive care unit (PICU), and many children receive opioid prescription(s) at discharge. The frequency of opioid prescriptions at discharge and associations with individual characteristics and clinical factors are unknown. This study aimed to [...] Read more.
Opioids are commonly used to treat pain in the pediatric intensive care unit (PICU), and many children receive opioid prescription(s) at discharge. The frequency of opioid prescriptions at discharge and associations with individual characteristics and clinical factors are unknown. This study aimed to identify (1) the number of children who receive an opioid prescription at PICU discharge and (2) the demographic and clinical factors associated with receiving an opioid prescription. Data were collected via the electronic medical record. The sample was 3345 children (birth to 18 years) admitted to the PICU and discharged to home or an inpatient rehabilitation setting. In total, 23.7% of children were prescribed an opioid at discharge. There were group differences in who received opioid prescriptions (yes/no) related to PICU diagnosis, length of hospital stay, number of days on mechanical ventilation, number of previous hospitalizations, organ dysfunction score, and admission type (surgical versus non-surgical). Binary logistic regression models examined predictors of opioid prescription at discharge for the total sample and diagnostic subgroups. Older age and surgical admission type were the most consistent predictors of receiving an opioid prescription. Future research should examine prescription usage patterns and how use of opioids is associated with pain and functional outcomes over time. Full article
(This article belongs to the Special Issue Pediatric Neurocritical Care and Neurotrauma Recovery)
10 pages, 656 KiB  
Article
Mobilization of Children with External Ventricular Drains: A Retrospective Cohort Study
by Ben Reader, Emily Stegeman, Nanhua Zhang and Kelly Greve
Children 2022, 9(11), 1777; https://0-doi-org.brum.beds.ac.uk/10.3390/children9111777 - 19 Nov 2022
Viewed by 1565
Abstract
The implementation of early mobility programs for children with critical illnesses has been growing. Children with acute neurologic conditions that result in the requirement of an external ventricular drain (EVD) may be excluded from attaining the benefits of early mobility programs due to [...] Read more.
The implementation of early mobility programs for children with critical illnesses has been growing. Children with acute neurologic conditions that result in the requirement of an external ventricular drain (EVD) may be excluded from attaining the benefits of early mobility programs due to the fear of adverse events. The purpose of this study was to examine the implementation, safety, and outcomes of children with EVDs mobilized by physical therapists. A single-site retrospective cohort study of children with EVDs mobilized by physical therapy (PT) was conducted. Patients aged 3–21 years who were hospitalized from September 2016 to December 2020 were included in this study. Results: Out of a total of 192 electronic health records with EVDs, 168 patients (87.5%) participated in 1601 early mobilization encounters led by physical therapists. No adverse events occurred due to mobilization. Patients mobilized more frequently by PT had a higher level of activity at discharge (p = 0.014), a shorter length of stay (p = 0.001), and a more favorable discharge (p = 0.03). The early mobilization of children with EVDs can be implemented safely without adverse events. Patients mobilized with an EVD are more functional at discharge, spend fewer days in the hospital, and have a more favorable discharge compared to those who do not receive PT. Full article
(This article belongs to the Special Issue Pediatric Neurocritical Care and Neurotrauma Recovery)
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12 pages, 957 KiB  
Article
Magnetic Resonance Imaging Findings in Infants with Severe Traumatic Brain Injury and Associations with Abusive Head Trauma
by Nikki Miller Ferguson, Susan Rebsamen, Aaron S. Field, Jose M. Guerrero, Bedda L. Rosario, Aimee T. Broman, Paul J. Rathouz, Michael J. Bell, Andrew L. Alexander and Peter A. Ferrazzano
Children 2022, 9(7), 1092; https://0-doi-org.brum.beds.ac.uk/10.3390/children9071092 - 21 Jul 2022
Cited by 3 | Viewed by 1976
Abstract
Young children with severe traumatic brain injury (TBI) have frequently been excluded from studies due to age and/or mechanism of injury. Magnetic resonance imaging (MRI) is now frequently being utilized to detect parenchymal injuries and early cerebral edema. We sought to assess MRI [...] Read more.
Young children with severe traumatic brain injury (TBI) have frequently been excluded from studies due to age and/or mechanism of injury. Magnetic resonance imaging (MRI) is now frequently being utilized to detect parenchymal injuries and early cerebral edema. We sought to assess MRI findings in infants with severe TBI, and to determine the association between specific MRI findings and mechanisms of injury, including abusive head trauma (AHT). MRI scans performed within the first 30 days after injury were collected and coded according to NIH/NINDS Common Data Elements (CDEs) for Neuroimaging in subjects age < 2 years old with severe TBI enrolled in the Approaches and Decisions in Acute Pediatric Traumatic Brain Injury Trial. Demographics and injury characteristics were analyzed. A total of 81 children were included from ADAPT sites with MRI scans. Median age was 0.77 years and 57% were male. Most common MRI finding was ischemia, present in 57/81 subjects (70%), in a median of 7 brain regions per subject. Contusion 46/81 (57%) and diffuse axonal injury (DAI) 36/81 (44.4%) subjects followed. Children were dichotomized based on likelihood of AHT with 43/81 subjects classified as AHT. Ischemia was found to be significantly associated with AHT (p = 0.001) and “inflicted” injury mechanism (p = 0.0003). In conclusion, the most common intracerebral injury seen on MRI of infants with severe TBI was ischemia, followed by contusion and DAI. Ischemia was associated with AHT, and ischemia affecting > 4 brain regions was predictive of AHT. Full article
(This article belongs to the Special Issue Pediatric Neurocritical Care and Neurotrauma Recovery)
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9 pages, 647 KiB  
Article
A Virtual Community of Practice: An International Educational Series in Pediatric Neurocritical Care
by Jennifer C. Erklauer, Ajay X. Thomas, Sue J. Hong, Brian L. Appavu, Jessica L. Carpenter, Nicolas R. Chiriboga-Salazar, Peter A. Ferrazzano, Zachary Goldstein, Jennifer L. Griffith, Kristin P. Guilliams, Matthew P. Kirschen, Karen Lidsky, Marlina E. Lovett, Brandon McLaughlin, Jennifer C. Munoz Pareja, Sarah Murphy, Wendy O'Donnell, James J. Riviello, Michelle E. Schober, Alexis A. Topjian, Mark S. Wainwright, Dennis W. Simon and Pediatric Neurocritical Care Research Groupadd Show full author list remove Hide full author list
Children 2022, 9(7), 1086; https://0-doi-org.brum.beds.ac.uk/10.3390/children9071086 - 20 Jul 2022
Cited by 1 | Viewed by 2361
Abstract
Pediatric neurocritical care (PNCC) is a rapidly growing field. Challenges posed by the COVID-19 pandemic on trainee exposure to educational opportunities involving direct patient care led to the creative solutions for virtual education supported by guiding organizations such as the Pediatric Neurocritical Care [...] Read more.
Pediatric neurocritical care (PNCC) is a rapidly growing field. Challenges posed by the COVID-19 pandemic on trainee exposure to educational opportunities involving direct patient care led to the creative solutions for virtual education supported by guiding organizations such as the Pediatric Neurocritical Care Research Group (PNCRG). Our objective is to describe the creation of an international, peer-reviewed, online PNCC educational series targeting medical trainees and faculty. More than 1600 members of departments such as pediatrics, pediatric critical care, and child neurology hailing from 75 countries across six continents have participated in this series over a 10-month period. We created an online educational channel in PNCC with over 2500 views to date and over 130 followers. This framework could serve as a roadmap for other institutions and specialties seeking to address the ongoing problems of textbook obsolescence relating to the rapid acceleration in knowledge acquisition, as well as those seeking to create new educational content that offers opportunities for an interactive, global audience. Through the creation of a virtual community of practice, we have created an international forum for pediatric healthcare providers to share and learn specialized expertise and best practices to advance global pediatric health. Full article
(This article belongs to the Special Issue Pediatric Neurocritical Care and Neurotrauma Recovery)
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9 pages, 1018 KiB  
Article
Exploring Trends in Neuromonitoring Use in a General Pediatric ICU: The Need for Standardized Guidance
by Nathan Chang and Lindsey Rasmussen
Children 2022, 9(7), 934; https://0-doi-org.brum.beds.ac.uk/10.3390/children9070934 - 22 Jun 2022
Cited by 3 | Viewed by 1939
Abstract
Neuromonitoring has become more standardized in adult neurocritical care, but the utility of different neuromonitoring modalities in children remains debated. We aimed to describe the use of neuromonitoring in critically ill children with and without primary neurological diseases. We conducted a retrospective review [...] Read more.
Neuromonitoring has become more standardized in adult neurocritical care, but the utility of different neuromonitoring modalities in children remains debated. We aimed to describe the use of neuromonitoring in critically ill children with and without primary neurological diseases. We conducted a retrospective review of patients admitted to a 32-bed, non-cardiac PICU during a 12-month period. Neuro-imaging, electroencephalogram (EEG), cerebral oximetry (NIRS), automated pupillometry, transcranial doppler (TCD), intracranial pressure (ICP) monitoring, brain tissue oxygenation (PbtO2), primary diagnosis, and outcome were extracted. Neuromonitoring use by primary diagnosis and associations with outcome were observed. Of 1946 patients, 420 received neuro-imaging or neuromonitoring. Primary non-neurological diagnoses most frequently receiving neuromonitoring were respiratory, hematologic/oncologic, gastrointestinal/liver, and infectious/inflammatory. The most frequently used technologies among non-neurological diagnoses were neuro-imaging, EEG, pupillometry, and NIRS. In the multivariate analysis, pupillometry use was associated with mortality, and EEG, NIRS, and neuro-imaging use were associated with disability. Frequencies of TCD and PbtO2 use were too small for analysis. Neuromonitoring is prevalent among various diagnoses in the PICU, without clear benefit on outcomes when used in an ad hoc fashion. We need standard guidance around who, when, and how neuromonitoring should be applied to improve the care of critically ill children. Full article
(This article belongs to the Special Issue Pediatric Neurocritical Care and Neurotrauma Recovery)
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17 pages, 318 KiB  
Article
Sleep and Executive Functioning in Pediatric Traumatic Brain Injury Survivors after Critical Care
by Cydni N. Williams, Cindy T. McEvoy, Miranda M. Lim, Steven A. Shea, Vivek Kumar, Divya Nagarajan, Kurt Drury, Natalia Rich-Wimmer and Trevor A. Hall
Children 2022, 9(5), 748; https://0-doi-org.brum.beds.ac.uk/10.3390/children9050748 - 19 May 2022
Cited by 3 | Viewed by 1754
Abstract
Over 50,000 children are hospitalized annually for traumatic brain injury (TBI) and face long-term cognitive morbidity. Over 50% develop sleep/wake disturbances (SWDs) that can affect brain development and healing. We hypothesized SWDs would portend worse executive function outcomes in children aged 3–18 years [...] Read more.
Over 50,000 children are hospitalized annually for traumatic brain injury (TBI) and face long-term cognitive morbidity. Over 50% develop sleep/wake disturbances (SWDs) that can affect brain development and healing. We hypothesized SWDs would portend worse executive function outcomes in children aged 3–18 years with TBI 1–3 months after hospital discharge. SWDs were defined using the Sleep Disturbances Scale for Children (t-scores ≥ 60). Outcomes included the Global Executive Composite (GEC, t-score) from the Behavior Rating Inventory of Executive Function, Second and Preschool Editions, and multiple objective executive function assessments combined through Principal Components Analysis into a Neurocognitive Index (NCI, z-score). Multiple linear regression evaluated associations between SWDs and executive function outcomes, controlling for covariates. Among 131 children, 68% had clinically significant SWDs, which were associated with significantly worse median scores on the GEC (56 vs. 45) and NCI (−0.02 vs. 0.42; both p < 0.05). When controlling for baseline characteristics and injury severity in multivariable analyses, SWDs were associated with worse GEC (β-coefficient = 7.8; 95% Confidence Interval = 2.5, 13.1), and worse NCI (β-coefficient = −0.4; 95% Confidence Interval = −0.8, −0.04). SWDs in children with TBI are associated with worse executive function outcomes after hospital discharge, and may serve as modifiable targets to improve outcomes. Full article
(This article belongs to the Special Issue Pediatric Neurocritical Care and Neurotrauma Recovery)
14 pages, 996 KiB  
Article
Carbon Dioxide Reactivity of Brain Tissue Oxygenation after Pediatric Traumatic Brain Injury
by Damla Hanalioglu, Ann Oh, M’Hamed Temkit, P. David Adelson and Brian Appavu
Children 2022, 9(3), 409; https://0-doi-org.brum.beds.ac.uk/10.3390/children9030409 - 14 Mar 2022
Cited by 4 | Viewed by 1770
Abstract
Background: We investigated how changes in partial pressure of brain tissue oxygenation (PbtO2) relate to end-tidal carbon dioxide (EtCO2) after pediatric traumatic brain injury (TBI). Methods: Dynamic structural equation modeling (DSEM) was used to investigate associations between EtCO2 [...] Read more.
Background: We investigated how changes in partial pressure of brain tissue oxygenation (PbtO2) relate to end-tidal carbon dioxide (EtCO2) after pediatric traumatic brain injury (TBI). Methods: Dynamic structural equation modeling (DSEM) was used to investigate associations between EtCO2 and PbtO2, with positive associations indicating intact CO2 reactivity of PbtO2, and negative associations indicating impaired reactivity. Sub-analyses were performed to investigate associations of PbtO2 to intracranial pressure (ICP), arterial blood pressure (ABP) and cerebral regional oximetry (rSO2). Results: Among 14 patients, a positive association between PbtO2 and EtCO2 was demonstrated (SRC 0.05, 95% CI [0.04, 0.06]), with 9 patients demonstrating intact CO2 reactivity and 5 patients demonstrating impaired reactivity. Patients demonstrating intact CO2 reactivity had positive associations between PbtO2 and ICP (0.22 [0.21, 0.23]), whereas patients with impaired reactivity had negative associations (−0.28 [−0.29, −0.28]). Patients demonstrating intact CO2 reactivity had negative associations between PbtO2 and rSO2 (−0.08 [−0.09, −0.08]), whereas patients with impaired reactivity had positive associations (−0.15 [0.14, 0.16]). Compared to patients with intact CO2 reactivity, those with impaired reactivity had increased ICP (p < 0.0000), lower PbtO2 (p < 0.0000) and higher PRx (p = 0.0134). Conclusion: After TBI, CO2 reactivity of PbtO2 can be heterogenous, necessitating further work investigating factors contributing toward impaired reactivity. Full article
(This article belongs to the Special Issue Pediatric Neurocritical Care and Neurotrauma Recovery)
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Review

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17 pages, 646 KiB  
Review
Brain-Directed Care: Why Neuroscience Principles Direct PICU Management beyond the ABCs
by Debbie A. Long, Michaela Waak, Nicola N. Doherty and Belinda L. Dow
Children 2022, 9(12), 1938; https://0-doi-org.brum.beds.ac.uk/10.3390/children9121938 - 09 Dec 2022
Cited by 1 | Viewed by 2797
Abstract
Major advances in pediatric intensive care (PICU) have led to increased child survival. However, the long-term outcomes among these children following PICU discharge are a concern. Most children admitted to PICU are under five years of age, and the stressors of critical illness [...] Read more.
Major advances in pediatric intensive care (PICU) have led to increased child survival. However, the long-term outcomes among these children following PICU discharge are a concern. Most children admitted to PICU are under five years of age, and the stressors of critical illness and necessary interventions can affect their ability to meet crucial developmental milestones. Understanding the neuroscience of brain development and vulnerability can inform PICU clinicians of new ways to enhance and support the care of these most vulnerable children and families. This review paper first explores the evidence-based neuroscience principles of brain development and vulnerability and the impact of illness and care on children’s brains and ultimately wellbeing. Implications for clinical practice and training are further discussed to help optimize brain health in children who are experiencing and surviving a critical illness or injury. Full article
(This article belongs to the Special Issue Pediatric Neurocritical Care and Neurotrauma Recovery)
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17 pages, 723 KiB  
Review
Social Functioning and Autistic Behaviors in Youth Following Acquired Brain Injury
by Rachel K. Greene, Natalia Rich-Wimmer, Cydni N. Williams and Trevor A. Hall
Children 2022, 9(11), 1648; https://0-doi-org.brum.beds.ac.uk/10.3390/children9111648 - 28 Oct 2022
Cited by 1 | Viewed by 1400
Abstract
Children and adolescents who survive the pediatric intensive care unit (PICU) with an acquired brain injury (ABI) often demonstrate a variety of physical, cognitive, emotional/behavioral, and social sequelae termed post-intensive care syndrome (PICS). Social communication and interaction challenges have also been observed clinically, [...] Read more.
Children and adolescents who survive the pediatric intensive care unit (PICU) with an acquired brain injury (ABI) often demonstrate a variety of physical, cognitive, emotional/behavioral, and social sequelae termed post-intensive care syndrome (PICS). Social communication and interaction challenges have also been observed clinically, and there is growing literature documenting these occurrences in youth following ABI. The extent of these social changes varies among patients, and a subset of patients go on to exhibit social and behavioral profiles closely resembling those of autistic youth. We reviewed empirical research regarding social functioning in youth following ABI, as well as the overlap between individuals with ABI and autistic youth, published from January 2009 to August 2022 on PubMed and Scopus databases. Clinical case examples from a well-established post-PICU follow-up program are also provided to exemplify the complexity of this phenomenon. Full article
(This article belongs to the Special Issue Pediatric Neurocritical Care and Neurotrauma Recovery)
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20 pages, 1007 KiB  
Review
Is Pediatric Intensive Care Trauma-Informed? A Review of Principles and Evidence
by Lauren A. Demers, Naomi M. Wright, Avi J. Kopstick, Claire E. Niehaus, Trevor A. Hall, Cydni N. Williams and Andrew R. Riley
Children 2022, 9(10), 1575; https://0-doi-org.brum.beds.ac.uk/10.3390/children9101575 - 18 Oct 2022
Cited by 6 | Viewed by 2974
Abstract
Pediatric critical illness and injury, along with the experience of recovering from critical illness are among the most potentially traumatic experiences for children and their families. Additionally, children often come to the Pediatric Intensive Care Unit (PICU) with pre-existing trauma that may sensitize [...] Read more.
Pediatric critical illness and injury, along with the experience of recovering from critical illness are among the most potentially traumatic experiences for children and their families. Additionally, children often come to the Pediatric Intensive Care Unit (PICU) with pre-existing trauma that may sensitize them to PICU-related distress. Trauma-informed care (TIC) in the PICU, while under-examined, has the potential to enhance quality of care, mitigate trauma-related symptoms, encourage positive coping, and provide anticipatory guidance for the recovery process. This narrative review paper first describes the need for TIC in the PICU and then introduces the principles of TIC as outlined by the American Academy of Pediatrics: awareness, readiness, detection and assessment, management, and integration. Current clinical practices within PICU settings are reviewed according to each TIC principle. Discussion about opportunities for further development of TIC programs to improve patient care and advance knowledge is also included. Full article
(This article belongs to the Special Issue Pediatric Neurocritical Care and Neurotrauma Recovery)
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12 pages, 10454 KiB  
Review
The Role of Electroencephalography in the Prognostication of Clinical Outcomes in Critically Ill Children: A Review
by Carley A. Gilman, Courtney J. Wusthoff and Réjean M. Guerriero
Children 2022, 9(9), 1368; https://0-doi-org.brum.beds.ac.uk/10.3390/children9091368 - 08 Sep 2022
Viewed by 1679
Abstract
Electroencephalography (EEG) is a neurologic monitoring modality that allows for the identification of seizures and the understanding of cerebral function. Not only can EEG data provide real-time information about a patient’s clinical status, but providers are increasingly using these results to understand short [...] Read more.
Electroencephalography (EEG) is a neurologic monitoring modality that allows for the identification of seizures and the understanding of cerebral function. Not only can EEG data provide real-time information about a patient’s clinical status, but providers are increasingly using these results to understand short and long-term prognosis in critical illnesses. Adult studies have explored these associations for many years, and now the focus has turned to applying these concepts to the pediatric literature. The aim of this review is to characterize how EEG can be utilized clinically in pediatric intensive care settings and to highlight the current data available to understand EEG features in association with functional outcomes in children after critical illness. In the evaluation of seizures and seizure burden in children, there is abundant data to suggest that the presence of status epilepticus during illness is associated with poorer outcomes and a higher risk of mortality. There is also emerging evidence indicating that poorly organized EEG backgrounds, lack of normal sleep features and lack of electrographic reactivity to clinical exams portend worse outcomes in this population. Prognostication in pediatric critical illness must be informed by the comprehensive evaluation of a patient’s clinical status but the utilization of EEG may help contribute to this assessment in a meaningful way. Full article
(This article belongs to the Special Issue Pediatric Neurocritical Care and Neurotrauma Recovery)
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18 pages, 359 KiB  
Review
Back to School: Academic Functioning and Educational Needs among Youth with Acquired Brain Injury
by W. Michael Vanderlind, Lauren A. Demers, Georgina Engelson, Rollen C. Fowler and Melissa McCart
Children 2022, 9(9), 1321; https://0-doi-org.brum.beds.ac.uk/10.3390/children9091321 - 30 Aug 2022
Viewed by 1700
Abstract
Youth with a history of traumatic or non-traumatic acquired brain injury are at increased risk for long-lasting cognitive, emotional, behavioral, social, and physical sequelae post-injury. Such sequelae have great potential to negatively impact this population’s academic functioning. Consistently, poorer academic achievement and elevated [...] Read more.
Youth with a history of traumatic or non-traumatic acquired brain injury are at increased risk for long-lasting cognitive, emotional, behavioral, social, and physical sequelae post-injury. Such sequelae have great potential to negatively impact this population’s academic functioning. Consistently, poorer academic achievement and elevated need for educational supports have been well-documented among youth with a history of acquired brain injury. The current paper reviews the literature on neuropsychological, psychiatric, and academic outcomes of pediatric acquired brain injury. A discussion of special education law as it applies to this patient population, ongoing limitations within the field, and a proposal of solutions are also included. Full article
(This article belongs to the Special Issue Pediatric Neurocritical Care and Neurotrauma Recovery)
12 pages, 5863 KiB  
Review
Transcranial Doppler Ultrasound, a Review for the Pediatric Intensivist
by Marlina Elizabeth Lovett and Nicole F. O’Brien
Children 2022, 9(5), 727; https://0-doi-org.brum.beds.ac.uk/10.3390/children9050727 - 16 May 2022
Cited by 6 | Viewed by 3458
Abstract
The use of transcranial Doppler ultrasound (TCD) is increasing in frequency in the pediatric intensive care unit. This review highlights some of the pertinent TCD applications for the pediatric intensivist, including evaluation of cerebral hemodynamics, autoregulation, non-invasive cerebral perfusion pressure/intracranial pressure estimation, vasospasm [...] Read more.
The use of transcranial Doppler ultrasound (TCD) is increasing in frequency in the pediatric intensive care unit. This review highlights some of the pertinent TCD applications for the pediatric intensivist, including evaluation of cerebral hemodynamics, autoregulation, non-invasive cerebral perfusion pressure/intracranial pressure estimation, vasospasm screening, and cerebral emboli detection. Full article
(This article belongs to the Special Issue Pediatric Neurocritical Care and Neurotrauma Recovery)
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14 pages, 4450 KiB  
Review
Advanced Ultrasound Techniques for Neuroimaging in Pediatric Critical Care: A Review
by Colbey W. Freeman and Misun Hwang
Children 2022, 9(2), 170; https://0-doi-org.brum.beds.ac.uk/10.3390/children9020170 - 30 Jan 2022
Cited by 10 | Viewed by 3207
Abstract
Because of its portability, safety profile, and accessibility, ultrasound has been integral in pediatric neuroimaging. While conventional B-mode and Doppler ultrasound provide anatomic and limited flow information, new and developing advanced ultrasound techniques are facilitating real-time visualization of brain perfusion, microvascular flow, and [...] Read more.
Because of its portability, safety profile, and accessibility, ultrasound has been integral in pediatric neuroimaging. While conventional B-mode and Doppler ultrasound provide anatomic and limited flow information, new and developing advanced ultrasound techniques are facilitating real-time visualization of brain perfusion, microvascular flow, and changes in tissue stiffness in the brain. These techniques, which include contrast-enhanced ultrasound, microvascular imaging, and elastography, are providing new insights into and new methods of evaluating pathologies affecting children requiring critical care, including hypoxic–ischemic encephalopathy, stroke, and hydrocephalus. This review introduces advanced neurosonography techniques and their clinical applications in pediatric neurocritical care. Full article
(This article belongs to the Special Issue Pediatric Neurocritical Care and Neurotrauma Recovery)
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Other

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9 pages, 526 KiB  
Opinion
A Commentary on Electrographic Seizure Management and Clinical Outcomes in Critically Ill Children
by Lily Tran, Rebecca Welcher and Rodney Scott
Children 2023, 10(2), 258; https://0-doi-org.brum.beds.ac.uk/10.3390/children10020258 - 31 Jan 2023
Viewed by 1879
Abstract
Continuous EEG (cEEG) monitoring is the gold standard for detecting electrographic seizures in critically ill children and the current consensus-based guidelines recommend urgent cEEG to detect electrographic seizures that would otherwise be undetected. The detection of seizures usually leads to the use of [...] Read more.
Continuous EEG (cEEG) monitoring is the gold standard for detecting electrographic seizures in critically ill children and the current consensus-based guidelines recommend urgent cEEG to detect electrographic seizures that would otherwise be undetected. The detection of seizures usually leads to the use of antiseizure medications, even though current evidence that treatment leads to important improvements in outcomes is limited, raising the question of whether the current strategies need re-evaluation. There is emerging evidence indicating that the presence of electrographic seizures is not associated with unfavorable neurological outcome, and thus treatment is unlikely to alter the outcomes in these children. However, a high seizure burden and electrographic status epilepticus is associated with unfavorable outcome and the treatment of status epilepticus is currently warranted. Ultimately, outcomes are more likely a function of etiology than of a direct effect of the seizures themselves. We suggest re-examining our current consensus toward aggressive treatment to abolish all electrographic seizures and recommend a tailored approach where therapeutic interventions are indicated when seizure burden breaches above a critical threshold that may be associated with adverse outcomes. Future studies should explicitly evaluate whether there is a positive impact of treating electrographic seizures or electrographic status epilepticus in order to justify continuing current approaches. Full article
(This article belongs to the Special Issue Pediatric Neurocritical Care and Neurotrauma Recovery)
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7 pages, 859 KiB  
Case Report
Pediatric Stroke due to Thoracic Outlet Syndrome Treated with Thrombolysis and Thrombectomy: A Case Report
by Dhanalakshmi Angappan, McKinnon Garrett, Candice Henry, Art Riddle and Jenny L. Wilson
Children 2022, 9(6), 875; https://0-doi-org.brum.beds.ac.uk/10.3390/children9060875 - 12 Jun 2022
Viewed by 2010
Abstract
Thoracic outlet syndrome (TOS) is a condition that results from the compression of neurovascular structures as they exit the thorax. Arterial ischemic stroke can occur in TOS due to retrograde embolism from the subclavian artery. We describe a 15-year-old girl who presented with [...] Read more.
Thoracic outlet syndrome (TOS) is a condition that results from the compression of neurovascular structures as they exit the thorax. Arterial ischemic stroke can occur in TOS due to retrograde embolism from the subclavian artery. We describe a 15-year-old girl who presented with left hemiplegia after 2 weeks of right arm numbness and tingling. Imaging showed an acute ischemic stroke due to a right middle cerebral artery occlusion. She was treated with intravenous tissue plasminogen activator at 1.3 h and mechanical thrombectomy at 2.4 h with successful recanalization. Review of her neck computed tomography angiogram suggested a right subclavian artery aneurysm, and upper-extremity imaging also demonstrated distal thrombosis and fusion of right first and second ribs, which was consistent with thoracic outlet syndrome. Three days later, she underwent a right subclavian artery aneurysm repair, right brachial and ulnar artery thrombectomy, and first rib resection. Three months later, she demonstrated good neurologic recovery. TOS is an uncommon cause of stroke in children, which may be heralded by upper-extremity symptoms. Interventionalists should be aware of the possibility of vascular anomalies in children; however, this finding does not exclude the possibility of acute stroke intervention. Full article
(This article belongs to the Special Issue Pediatric Neurocritical Care and Neurotrauma Recovery)
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