Pediatric traumatic brain injury: not just little adults.
OBJECTIVE
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.


RESULTS
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.


CONCLUSIONS
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.
Giza
Christopher C
CC
Division of Neurology, Department of Pediatrics, Mattel Children's Hospital at UCLA, Los Angeles, California, USA. cgiza@mednet.ucla.edu
Mink
Richard B
RB
Madikians
Andranik
A
D000367:Age Factors; D000777:Anesthetics / Q000009:adverse effects; D000927:Anticonvulsants / Q000009:adverse effects; D001930:Brain Injuries / Q000150:complications* / Q000534:rehabilitation / Q000628:therapy; D002560:Cerebrovascular Circulation; D002648:Child; D002658:Developmental Disabilities / Q000209:etiology*; D006801:Humans; D010372:Pediatrics / Q000639:trends*; D013997:Time Factors
D000777:Anesthetics; D000927:Anticonvulsants