Abstract and Introduction
Coma is a relatively common condition in the pediatric intensive care unit. Although the principles of diagnosis and management are basically the same for both children and adults, there are some age-specific aspects related to infants and children under 16 years of age that influences the pediatric intensive care practitioner's conduct. Several aspects regarding neuroplasticity, raised intracranial pressure and epileptogenesis in the immature brain are considered in this article. Importantly, the role of new technologies employed for neurophysiologic monitoring is also reviewed. The aim of this article is to evaluate the main issues comprising the comatose state in childhood and their differences from the same condition in adulthood. Several differences in the physiology of immature brains can affect clinical and neurophysiologic expression in a disorder of consciousness and may need special proceedings for its management. Future perspectives in the field are referred in the final part of this article.
Coma is a relatively common condition in critical pediatric care. Epidemiological studies generally divide studies by traumatic and nontraumatic causes. In a population-based study in the Northern region of the UK, the incidence of nontraumatic coma was five-times greater in children under 16 years of age than in the general population (30.8 per 100,000 vs 6.0 per 100,000 per year, respectively), with a notably higher incidence in the first year of life (160 per 100,000 children per year).
Infection is the most common overall cause of coma in childhood, with an overall mortality of 46%. Regarding traumatic brain injury in children, there were an estimated 546,240 children with head injuries not associated with motor vehicles in the USA during 1978 who required emergency room care. Head injuries account for 11% of hospital emergency room visits by children with nonmotor vehicle trauma. A fifth of head injuries among adolescents were associated with concussion. Among the 33,635 cases of concussion in children studied, twice as many males had concussion than females.
Pediatr Health. 2010;4(6):581-589. © 2010 Future Medicine Ltd.
Cite this: Considerations for the Pediatric Coma Patient: Not Just Small Adults - Medscape - Dec 01, 2010.