Age-specific characteristics of brain death in children
J. C. Fackler, J. C. Troncoso and F. R. Gioia
Department of Anesthesiology/Critical Care Medicine, Johns Hopkins Hospital, Baltimore.
Clinical and neuropathologic characteristics of 45 children who met
criteria for brain death were analyzed. Children between 2 months and 1
year of age were compared with children older than 1 year and children
older than 5 years. The observation period to fulfill brain death criteria
was not different between the age groups. Deep tendon and spinal reflexes
were preserved significantly less frequently in children younger than 1
year old. Diabetes insipidus and the necessity of inotropic support were
significantly more frequent in children older than 5 years. Fifty-eight
percent (26/45) of patients had no cerebral perfusion pressure before
death. However, 18% (8/45) of patients never had a cerebral perfusion
pressure below 40 mm Hg. No relationships could be shown between the
clinical or physiologic factors and neuropathologic findings. We found no
support for using different brain-death criteria for children between 2
months and 1 year of age.
