Evaluation of Brain Death in Children: A Single Center Experience

Abstract

Introduction: Brain death is defined as a status of apnea, coma and the absence of brainstem reflexes, in addition to the presence of electrocerebral silence (ECS) on an electroencephalography (EEG). Trauma and anoxic encephalopathy are the most common causes of brain death in children, with incidences of brain death reported to vary between 0.65-1.2 percent. A diagnosis of brain death can be made based on a detailed anamnesis, physical examination findings and supportive test results. When pediatric patients are being evaluated by EEG, they should also be assessed in terms of medications, metabolic encephalopathy, hypothermia, electrolyte imbalance and acid-base imbalance. Patients and Methods:The present study included patients who suffered brain death during hospitalization in the pediatric intensive care unit of Inonu University Turgut Ozal Medical Center between 2010 and 2017. The medical files of the patients were reviewed retrospectively. All patients included in the study underwent an EEG and an apnea test was performed on all patients. The cerebral blood flow (CBF) measurement was obtained through a Computerized Tomography Angiography (CTA), and all patients underwent a Magnetic Resonance Angiography (MRA) and a Transcranial Doppler Ultrasonography (TCD). Results:Of the 20 patients included in the study, nine (45%) were female and 11 (55%) were male, with a mean age of 8.47±5.73 years. Of the total, seven patients presented with fulminant hepatitis, three with trauma, three with sepsis, two with drowning, two with cerebrovaskuler disease (CVD), and one patient each with lymphoma, suicide and electric shock. The families of only two (10%) patients donated the organs of the deceased. Of the 20 patients, four were Syrian, and of which were being monitored with the diagnosis of liver failure. An apnea test was positive in all patients, and in all patients, the EEG findings supported brain death. Imaging methods were carried out to demonstrate the absence of CBF flow in 11 (55%) patients, and diabetes insipidus (DI) developed in nine (45%) of the patients with brain death. Conclusion:In conclusion, a multidisciplinary approach is required for the diagnosis of brain death. An evaluation of laboratory findings and EEG results together with the findings of a physical examination is important, particularly in centers like our clinics where more than 50 pediatric transplantations are carried out each year. The development of hypernatremia in patients with DI is now an important parameter in the loss of brain function. Keywords: Brain death, Childhood, EEG Aslan et al. / Brain Death in Children 510 ORTADOGU TIP DERG 2019; 11(4): 509-516 ÖZ Giriş ve Amaç: Beyin ölümü apne, koma ve beyin sapı reflekslerinin bulunmamasına ek olarak elektroserebral sessiz elektroensefalografi (EEG) bulunması durumudur. Çocuklarda beyin ölümü en sık travma ve anoksik ensefalopati sonucu ortaya çıkar. Beyin ölümü insidansının %0,65 ila %1,2 arasında değiştiğini bildirmiştir. Beyin ölümü tanısı iyi bir anamnez, fizik muayene ve yardımcı t...

Evaluation of Pediatric Brain Death and Organ Donation: 10-Year Experience in a Pediatric Intensive Care Unit in Turkey

“…They also revealed that the combination of EEG and AT was the most used ancillary method, in about 65% of their study cohort, like the observation in our study. 14 Aslan et al 18 from Turkey reported similarly high rates of ancillary tests in their study group, including 20 pediatric BD cases. In their report, they showed that they routinely use EEG and AT in 19 out of 20 patients, whereas CTA/MRA was applied to 8 patients (40%).…”

“…Sari et al 23 reported that the time to BD in their study group was in a range between 1 and 21 days, with a median of 3 days. 23 Aslan et al 18 reported a wider interval, with a range between 2 and 33 days and a mean of 11.1 days. 18 Özmert et al 21 reported that the time from BD declaration to cardiac arrest was a mean 6.9 days (0.2-25 days).…”

“… 23 Aslan et al 18 reported a wider interval, with a range between 2 and 33 days and a mean of 11.1 days. 18 Özmert et al 21 reported that the time from BD declaration to cardiac arrest was a mean 6.9 days (0.2-25 days). 21 In an adult study including 60 BD patients, the mean time from the diagnosis of brain death to somatic death was 2.4 ± 0.3 days in the non-donor group, and from 1.08 ± 0.2 days in the donor group.…”

“…In their report, they showed that they routinely use EEG and AT in 19 out of 20 patients, whereas CTA/MRA was applied to 8 patients (40%). 18 A study comparing pediatric and adult BD patients report that AT was performed in 83% of adults and 90% of the pediatric population. The same study reveals that the percentages of ancillary tests performed in adult and pediatric patients were 42% and 58%, respectively.…”