Quo Vadis 2010? – Carpe Diem: Challenges and Opportunities in Pediatric Traumatic Brain Injury

Abstract

Traumatic brain injury (TBI) in infants and children remains a public health problem of enormous magnitude. It is a complex and heterogeneous condition that presents many diagnostic, therapeutic and prognostic challenges. A number of investigative teams are studying pediatric TBI both in experimental models and in clinical studies at the bedside. This review builds on work presented in a prior supplement to Developmental Neuroscience that was published in 2006, and addresses several active areas of research on this topic, including (1) the application of novel imaging methods, (2) the use of serum and/or CSF biomarkers of injury, (3) advances in neuromonitoring, (4) the development and testing of novel therapies, (5) developments in modeling pediatric TBI, (6) the consideration of a new approach to classification of pediatric TBI, and (7) assessing the potential impact of the development of pediatric and neonatal neurocritical care services on the management and outcome of pediatric TBI.

Effects of local administration of allogenic adipose tissue-derived mesenchymal stem cells on functional recovery in experimental traumatic brain injury

“…Under aseptic conditions a left craniectomy of 4 mm (medial/lateral) by 6 mm (anterior/posterior) was performed, keeping the arachnoid [3,4,24,25]. In a co-ordinate system, taking bregma as the reference (0, 0), the co-ordinates of the craniotomy were placed between anterior (À3, 2), medial (À1, À1), lateral (À5, À1) and posterior (À3, À4).…”

“…Currently therapy for TBI is based on traditional support measures [4]. There are several drug therapies in development, although they have not yet reached clinical application [5].…”

Pediatric Neurocritical Care: A Short Survey of Current Perceptions and Practices

“…As appears to often be the case with the movement toward sub-specialization in medical practice, the evolution of a sub-specialized field of clinical care (pediatric neurocritical care) has been accompanied by a burgeoning biomedical science literature. This growing body of knowledge covers increasingly more complex understandings of brain development, brain injury, and potential mechanisms of brain protection and recovery [15,16].…”

Pediatric Neurocritical Care

“…In addition to the need to develop expertise and evidence-based guidelines for targeted neurological diseases, pediatric neurocritical care should also encompass and address the need for monitoring, support, and protection of the brain during all varieties of acute critical illness. The potential role of specialized pediatric neurocritical care services or dedicated neurocritical care units and the development of pediatric neurointensivists are the subject of much discussion [1,2,4,[189][190][191][192]. Pediatric neurocritical care training programs have been proposed and described.…”

“…Pediatric neurocritical care training programs have been proposed and described. These emphasize the benefit of broad cross-disciplinary training, including training in pediatric medicine, neurology, anesthesia, adult neurocritical and neurovascular, neurosurgical and pediatric critical care [190,191,193]. In addition, several models of pediatric neurocritical care delivery have been proposed.…”