Osmolar therapy in pediatric traumatic brain injury.

Objectives: To describe patterns of use for mannitol and hypertonic saline in children with traumatic brain injury, to evaluate any potential associations between hypertonic saline and mannitol use and patient demographic, injury, and treatment hospital characteristics, and to determine whether the 2003 guidelines for severe pediatric traumatic brain injury impacted clinical practice regarding osmolar therapy.

Design: Retrospective cohort study.

Setting: Pediatric Health Information System database, January, 2001 to December, 2008.

Monitoring and prediction of intracranial hypertension in pediatric traumatic brain injury: clinical factors and initial head computed tomography.

Background: Control of intracranial hypertension (ICH) in patients with traumatic brain injury (TBI) is standard care. However, predicting risk for ICH is essential to balance risks and benefits of intracranial pressure (ICP) monitoring. Current recommendations for ICP monitoring in pediatric trauma patients are extrapolated from adult studies.

Early post-traumatic seizures in moderate to severe pediatric traumatic brain injury: rates, risk factors, and clinical features.

We performed a retrospective, observational study at a level I pediatric trauma center of children with moderate-to-severe traumatic brain injury (TBI) from January 2002 to September 2006 to identify clinical and radiographic risk factors for early post-traumatic seizures (EPTS). Two hundred and ninety-nine children ages 0-15 years were evaluated, with 24 excluded because they died before the initial head computed tomography (CT) was obtained (n=20), or because their medical records were missing (n=4). Records were reviewed for accident characteristics, pre-hospital hypoxia or hypotension, initial non-contrast head CT characteristics, seizure occurrence, antiepileptic drug (AED) administration, and outcome.

Extracorporeal membrane oxygenation for pediatric respiratory failure: Survival and predictors of mortality.

Objective: The last multicentered analysis of extracorporeal membrane oxygenation in pediatric acute respiratory failure was completed in 1993. We reviewed recent international data to evaluate survival and predictors of mortality.

Design: Retrospective case series review.

Pediatric stroke: clinical characteristics, acute care utilization patterns, and mortality.

Purpose: Acute care utilization patterns are not well described but may help inform care coordination and treatment for pediatric stroke. The Kids Inpatient Database was queried to describe demographics and clinical characteristics of children with stroke, compare acute care utilization for hemorrhagic vs. ischemic stroke and Children's vs.

Early and sustained increase in the expression of hippocampal IGF-1, but not EPO, in a developmental rodent model of traumatic brain injury.

Pediatric traumatic brain injury (pTBI) is the leading cause of traumatic death and disability in children in the United States. Impaired learning and memory in these young survivors imposes a heavy toll on society. In adult TBI (aTBI) models, cognitive outcome improved after administration of erythropoietin (EPO) or insulin-like growth factor-1 (IGF-1).

Traumatic brain injury: preferred methods and targets for resuscitation.

Purpose Of Review: Severe traumatic brain injury (TBI) is the most common cause of death and disability in pediatric trauma. This review looks at the strategies to treat TBI in a temporal fashion. We examine the targets for resuscitation from field triage to definitive care in the pediatric ICU.

Traumatic brain injury during development reduces minimal clonic seizure thresholds at maturity.

Post-traumatic seizures affect 12-35% of children after traumatic brain injury (TBI) and are associated with worse cognitive and functional outcome, even after adjustment for severity of injury. Unfortunately, experimental models of pediatric post-traumatic epilepsy are lacking, and pathogenesis remains poorly understood. We have applied a standard model of TBI in immature rats to determine the effect of TBI on electroconvulsive seizure thresholds later in life.

Lower hospital mortality and complications after pediatric hematopoietic stem cell transplantation.

Objective: To assess protective and risk factors for mortality among pediatric patients during initial care after hematopoietic stem cell transplantation (HSCT) and to evaluate changes in hospital mortality.

Design: Retrospective cohort using the 1997, 2000, and 2003 Kids Inpatient Database, a probabilistic sample of children hospitalized in the United States with a procedure code for HSCT.

Setting: Hospitalized patients in the United States submitted to the database.

Strain and age affect electroconvulsive seizure testing in rats.

Electroconvulsive seizure thresholds were compared between adolescent and mature Sprague--Dawley, Wistar, and Fischer rats. All strains had similar hindbrain or forebrain seizure thresholds as adolescents. As adults, hindbrain or forebrain seizure thresholds were highest for Sprague--Dawley and lowest for Fischer rats.

Pediatric posttraumatic seizures: epidemiology, putative mechanisms of epileptogenesis and promising investigational progress.

Posttraumatic seizures and epilepsy are common in children experiencing traumatic brain injury and portend worse functional outcome. Unfortunately, the pathogenesis of pediatric posttraumatic seizures and epilepsy remains poorly understood, and no efficacious preventive therapy for post-traumatic epilepsy has been identified. This article reviews the epidemiology of pediatric posttraumatic seizures, discusses prominent putative mechanisms of posttraumatic epileptogenesis and highlights recent promising progress in experimental investigations of posttraumatic seizures and epilepsy.

Isoflurane exerts neuroprotective actions at or near the time of severe traumatic brain injury.

Isoflurane improves outcome vs. fentanyl anesthesia, in experimental traumatic brain injury (TBI). We assessed the temporal profile of isoflurane neuroprotection and tested whether isoflurane confers benefit at the time of TBI.

Comparison of seven anesthetic agents on outcome after experimental traumatic brain injury in adult, male rats.

Isoflurane is commonly used in experimental traumatic brain injury (TBI), both before and early after injury, yet it is rarely used clinically. Narcotics and benzodiazepines are frequently used after injury in clinical TBI. We compared seven anesthetic/sedative agents applied after injury in the controlled cortical impact model: diazepam, fentanyl, isoflurane, ketamine, morphine, pentobarbital, and propofol.

Hyperglycolysis is exacerbated after traumatic brain injury with fentanyl vs. isoflurane anesthesia in rats.

Despite common use of narcotics in the clinical management of severe traumatic brain injury (TBI), in experimental models rats treated with fentanyl have exhibited worse functional outcome and more CA1 hippocampal death than rats treated with standard isoflurane anesthesia. We hypothesized that greater post-traumatic excitotoxicity, reflected by cerebral glucose utilization (CMRglu), may account for detrimental effects of fentanyl vs. isoflurane.

Moderate hypothermia may be detrimental after traumatic brain injury in fentanyl-anesthetized rats.

Objectives: To determine whether transient, moderate hypothermia is beneficial after traumatic brain injury in fentanyl-anesthetized rats.

Design: Prospective, randomized study.

Setting: University-based animal research facility.