Pediatric Traumatic Brain Injury

Pediatric traumatic brain injury (TBI) is a major public health concern and challenge to critical care practitioners. The prevention of secondary injury is key to improving morbidity and mortality outcomes. Interventions are targeted at maintaining adequate cerebral blood flow and minimizing oxygen consumption by the brain. The anticipation and prevention of systemic complications are also of vital importance.

A new book focuses on evaluating what is currently known about childhood TBI and the challenges faced by researchers and clinicians in this arena. The book is entitled "Pediatric Traumatic Brain Injury: New Frontiers in Clinical and Translational Research," edited by Vicki Anderson and Keith Owen Yeates and published by Cambridge University Press. 

The following is an Introduction I ran across:

Traumatic brain injury (TBI) is a major public health problem among children and
adolescents. Surveillance data reveal that 1 in every 20 emergency department presentations at pediatric hospitals is for a TBI, making TBI more common than burns or
poisonings. For children, such injuries represent a common interruption to normal
development, with population estimates ranging from 200 to over 500 per 100 000 a year,
and with well-established variations across age and gender (Crowe et al., in press; Langlois et al., 2006).

The majority of TBI in children and adolescents are mild, typically with few
long-term consequences; however, a significant proportion of children will suffer more
serious injuries and will experience a range of residual physical, cognitive, educational,
functional, and social and emotional consequences, requiring the lifelong involvement of
health professionals across a range of disciplines and leading to a significant social
and economic burden for the children’s families and for the community more broadly
(Cassidy et al., 2004).

This book, New Frontiers in Pediatric Traumatic Brain Injury, aims to evaluate what we
have learned about TBI in childhood to date and, perhaps more importantly, to articulate
the challenges we face and how we should go forward in the future. Over the past two or
three decades, researchers and clinicians working with children with TBI have become
aware that injuries to the developing brain cannot be understood or treated in exactly the
same manner as those occurring in adulthood. Although we may be guided by science and
practice in adult TBI, unique developmental and contextual issues need to be taken into
account at all stages of recovery and treatment in children. Thus, a separate knowledge base is needed for pediatric TBI. As a consequence, until recently our understanding of recovery and outcomes in pediatric TBI has lagged behind that for adults. This is changing. Research in pediatric TBI now has more solid foundations. A number of principles have been established, some consistent with the adult literature, such as the predictive value of injury severity (Anderson et al., 2004; Taylor et al., 2008).

Others are specific to early brain injury, such as the unique mechanics and characteristic pathology of inflicted injury in children (Coats & Margulies, 2006; Prange & Margulies, 2002), or reflect the importance of developmental and contextual factors, such as the age at injury, developmental stage of brain development, and functional maturation (Anderson et al., 2005; Taylor & Alden, 1997), the key role of the family, and implications of life tasks specific to children (Yeates et al., 1997). 

Antidepressants

Recall the recent post I made raising the issue of whether antidepressants were properly relied on by patients and physicians.  That post can be accessed here. http://brainandspine.titololawoffice.com/2009/12/articles/psychiartric-psychological-iss/antidepressant-may-change-personality/

 A new study appears in the December issue of The Annals of Pharmacotherapy.  (Published Online, November 24, 2009. www.theannals.com, DOI 10.1345/aph.1M326) Suicidal adolescents who were prescribed an antidepressant medication during inpatient psychiatric hospital treatment were 85 percent less likely than others to be readmitted within a month after discharge.

The results provide additional evidence that antidepressants may play a key role in helping improve the mental health of suicidal youth. Cynthia Fontanella, co-author of the study and assistant professor of social work at Ohio State University, points out that the the findings are especially important now, because antidepressant use dropped in 2003 after the Food and Drug Administration issued a black box warning that some antidepressants may increase the risk of suicidal behavior for pediatric patients. A black-box warning is the most serious type of warning in prescription drug labeling.

Despite considerable recent attention and wide-scale interventionsby regulatory authorities that have changed drug usage patterns,the possible relationship between psychotropic pharmacotherapy and suicidal behavior among children and adolescents remainsunclear. Confounding by diagnosis adds to confusion in the interpretationof the relationship between antidepressant use and suicidal behavior among young people. Cynthia Fontanella's recent research suggests that antidepressants may be protective against early readmission after hospitalization for suicide attempts or ideation, but that psychotropic polypharmacy (although common) may be associated with increased risk of rehospitalization.There remains an urgent need for high-quality, ongoing research into these clinical dilemmas.

Once again, I invite your input and thoughts on this issue by posting a comment.
 

Newborn Brain Damage Stopped

Reporting their results in the Journal of Neuroscience, Scientists show that Inhibiting an enzyme in the brains of newborns suffering from oxygen and blood flow deprivation stops a type of brain damage that is a leading cause of cerebral palsy, mental retardation and death, according to researchers at Cincinnati Children's Hospital Medical Center.

This is a breakthrough which will save lives and promote healthy delivery of newborns.  Although it is still experimental.