Neurointensive care of the nonaccidentally injured child.
Childhood victims of NAT with severe brain injury require a multidisciplinary approach to their management if a good outcome is to occur. Despite the grave prognosis of these patients, an initial aggressive treatment strategy is warranted, because enough children go on to a meaningful life. A vigilant evaluation for multisystem injuries and vigorous resuscitation should be followed by prompt surgical intervention as indicated. Most NAT victims do not require surgical treatment of their brain injury, but do require ICP monitoring. A stepwise approach to the treatment of elevated ICP optimizes CPP, minimizes secondary brain injury, and increases the chances of a meaningful recovery. The future holds promise for these patients because a concerted effort is underway to understand pediatric TBI on a molecular level, and targeted therapies based on current basic research will certainly improve the neurointensive care, and eventual neurologic outcomes, of these children.
Stevenson
Kevin L
KL
Department of Neurological Surgery, Presbyterian University Hospital, Suite B-400, 200 Lothrop Street, Pittsburgh, PA 15213-2582, USA.
Adelson
P David
PD
D001930:Brain Injuries / Q000209:etiology / Q000628:therapy*; D002648:Child; D002649:Child Abuse; D006259:Craniocerebral Trauma / Q000628:therapy*; D003422:Critical Care / Q000379:methods*; D006801:Humans