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Pediatric traumatic brain injury (TBI) is a common condition. Recent advances in this area have included the development of quality of care indicators for the rehabilitation of children with TBI, efforts to identify means to prognosticate regarding outcomes including results of biomarker and imaging assessments, innovations in rehabilitation techniques including the application of various technologies, and continuing delineation of longterm outcomes. Application of the quality of care indicators support that pediatric-specific rehabilitation units are more likely to meet the quality of care indicators than all age units or those that admit a small number of children with TBI. Some biomarkers are showing promise, particularly when considering peak concentration, but extracranial injury makes their use challenging. Long-term outcome studies report continuing impairment years after injury. Evidence is still limited and would benefit from the application of standard definitions and use of consistent outcome measures.

Introduction Patients with cerebral palsy (CP) may receive intrathecal baclofen (ITB) to reduce muscle spasticity and dystonia. It can be challenging to identify the proper dose of ITB, and anecdotally these dosing needs may change after spinal fusion surgery. This study aimed to evaluate the need for changes in ITB dosing following a spinal fusion in pediatric neuromuscular scoliosis (NMS) patients and identify predisposing factors for those changes. Methods This was a retrospective case-control study of NMS patients with an ITB pump who later received a spinal fusion surgery. Dosing changes and the indications for the changes were postoperatively noted. Demographics, preoperative factors, and surgical factors were evaluated for correlation with dosing changes. Results A total of 49 patients were included in this study. Most had no change in ITB dose (71.4%), and others required a change that averaged about 10%. Male patients, those with larger pumps, and those that had a longer hospital stay were more likely to require a decrease in dose. Complications were similar between groups. Three catheters were revised during surgery: two continued on the same dose and one required an increase in dose after surgery. Conclusions Spinal fusion after ITB pump placement is feasible and safe. Most patients did not require dosing changes after spine fusion; however, careful evaluation postoperatively remains prudent.

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