What is new in pediatric traumatic brain injury?

Abstract

As TBI is the leading cause of death in children, research in this area is needed to advance our knowledge of the sequelae after and improve outcomes of children with TBI.

Age-Related Changes in the Oligodendrocyte Progenitor Pool Influence Brain Remodeling after Injury

“…This ongoing development is believed to be why pediatric patients appear to have an advantage over adult patients in some aspects of recovery following TBI [Giza et al, 2009;Johnston, 2009]. Contrary to this 'younger is better' paradigm, follow-up studies have shown that even mild TBI often has long-term behavioral effects, some of which appear to 'come out' with age as patients reach developmental milestones not achieved prior to injury [Giza et al, 2009;Goold and Vane, 2009;Sookplung and Vavilala, 2009]. The diverse neurological and cognitive effects of TBI have been found to have a particularly profound impact on hippocampal and forebrain function [Giza et al, 2009;Kernie and Parent, 2010].…”

“…With traumatic brain injury (TBI) as the leading cause of acquired brain injury in both children and adults, elucidating how damage occurs, the brain's response to that injury, and how both might be affected in order to obtain the best possible outcome are of significant clinical relevance [Giza and Prins, 2006;Yu et al, 2008;Giza et al, 2009;Sookplung and Vavilala, 2009]. The study of pediatric brain injury poses unique challenges because the sequelae of these injuries are age dependent.…”

“…The study of pediatric brain injury poses unique challenges because the sequelae of these injuries are age dependent. Similar injuries can have drastically different effects depending on the age at which they occur [Back et al, 2001;Giza and Prins, 2006;Giza et al, 2009;Sookplung and Vavilala, 2009]. In the past decade, neurogenesis in the adult central nervous system (CNS) has become a widely accepted phenomenon, and is now the subject of intense research for its therapeutic potential [Kernie and Parent, 2010].…”

“…Periventricular white matter injury encompasses a spectrum of white matter injuries including both focal cystic necrotic lesions, known as periventricular leukomalacia, and diffuse myelination disturbances [Back et al, 2007]. White matter changes also frequently accompany TBI and contribute to much of the morbidity associated with severe injury [Tasker et al, 2005;Tasker, 2006;Sookplung and Vavilala, 2009;Gale and Prigatano, 2010].…”

Induced mild hypothermia in children

“…We know that hypothermia reduces global cerebral metabolism, cerebral oxygen demands, lactic acid accumulation, calcium influx in neurocytes, free radicals production, lipid peroxidation, posttraumatic level of excitatory neurotransmitter, inhibition of apoptosis, and lowers the damage of cytoskeletal structure. (5) There is clear evidence of a beneficial effect of induced hypothermia on neurological outcome in patients following cardiac arrest (6,7) or in neonates with hypoxic -ischemic encephalopathy, (8) but things in traumatic brain injury are controversial. (9) In our study we aimed to determine the safety and effectiveness of MIH for pediatric patients after traumatic or posthypoxic brain injury.…”