Evaluation of BrainDeath inChildren:ASingleCenter Experience

Abstract

Abstract:Introduction: Brain death is defined as a status of apnea, coma and the absence of brainstem reflexes, in addition to thepresence of electrocerebral silence (ECS) on an electroencephalography (EEG). Trauma and anoxic encephalopathy are themost 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 testresults. When pediatric patients are being evaluated by EEG, they should also be assessed in terms of medications, metabolicencephalopathy, hypothermia, electrolyte imbalance and acid-base imbalance.Patients and Methods: The presentstudy included patients who suffered brain death during hospitalization in the pediatricintensive care unit of Inonu University Turgut Ozal Medical Center between 2010 and 2017. The medical files of the patientswere reviewed retrospectively. All patients included in the study underwent an EEG and an apnea test was performed on allpatients. 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 of8.47±5.73 years. Of the total, seven patients presented with fulminant hepatitis, three with trauma, three with sepsis, twowith 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 ofwhich 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 oflaboratory findings and EEG results together with the findings of a physical examination is important, particularly in centerslike our clinics where more than 50 pediatric transplantations are carried out each year. The development of hypernatremiain patients with DI is now an important parameter in the loss of brain function.