Article

Neurodevelopmental Consequences of Early Traumatic Brain Injury in 3-Year-Old Children

Department of Pediatrics, University of Utah, Salt Lake City, Utah, USA.
PEDIATRICS (Impact Factor: 5.47). 03/2007; 119(3):e616-23. DOI: 10.1542/peds.2006-2313
Source: PubMed

ABSTRACT

The purpose of this work was to determine cognitive and adaptive behavioral outcomes of children with traumatic brain injury acquired before age 2 years and to compare outcomes between inflicted versus noninflicted brain injury.
All North Carolina children hospitalized in an ICU for a traumatic brain injury before age 2 years between the years 2000 and 2001 were eligible for study entry. A total of 112 surviving children were prospectively identified, 52 (46%) of whom had complete follow-up. Thirty-one control children were recruited from preschool settings. Control subjects were chosen to be demographically similar to case subjects. Child measures of cognition and adaptive behavior at age 3 years were measured and compared between children with and without traumatic brain injury and children with inflicted and noninflicted traumatic brain injury.
Sixty percent of injured children were > 1 SD below normal on cognitive testing. Forty percent of injured children scored > 1 SD below normal on adaptive behavior testing. Children with inflicted traumatic brain injury performed more poorly on tests of cognition and adaptive behavior. Glasgow Coma Scale > or = 13, absence of seizures, income above twice the poverty guidelines, and high social capital were associated with improved outcomes. Injured children had lower scores than uninjured control children after adjustment for socioeconomic status.
Very young children with mild-to-severe traumatic brain injury as measured by the Glasgow Coma Scale are at risk for global cognitive deficits more than a year after the time of injury. Inflicted brain injury is associated with more severe injury and worse outcomes. This is less optimistic than findings in this same cohort 1 year after injury. Family characteristics seem to play a role in recovery after injury.

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    • "Recent reports suggest that mild TBI does have lasting cognitive and developmental effects for children injured younger than 2 yr old compared with age-matched uninjured children (Christensen et al. 2009; Keenan et al. 2007). "
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    ABSTRACT: It is estimated that approximately 1.5 million Americans suffer a traumatic brain injury (TBI) every year, of which approximately 80% are considered mild injuries. Because symptoms caused by mild TBI last less than half an hour by definition and apparently resolve without treatment, the study of mild TBI is often neglected resulting in a significant knowledge gap for this wide-spread problem. In this work, we studied functional (electrophysiological) alterations of the neonatal/juvenile hippocampus after experimental mild TBI. Our previous work reported significant cell death after in vitro injury >10% biaxial deformation. Here we report that biaxial deformation as low as 5% affected neuronal function during the first week after in vitro mild injury of hippocampal slice cultures. These results suggest that even very mild mechanical events may lead to a quantifiable neuronal network dysfunction. Furthermore, our results highlight that safe limits of mechanical deformation or tolerance criteria may be specific to a particular outcome measure and that neuronal function is a more sensitive measure of injury than cell death. In addition, the age of the tissue at injury was found to be an important factor affecting posttraumatic deficits in electrophysiological function, indicating a relationship between developmental status and vulnerability to mild injury. Our findings suggest that mild pediatric TBI could result in functional deficits that are more serious than currently appreciated.
    Preview · Article · Nov 2009 · Journal of Neurophysiology
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    • "Preschoolers who did and did not participate in the home visit portion of the study were comparable on variables such as rates of inflicted injury, gender, ethnicity, Glasgow Coma Scale (GCS) scores, age at injury, maternal age, maternal marital status, and maternal education level. See Keenan et al. (2007) for a detailed description of these variables. Children who sustained a non-penetrating TBI documented by CT scan, MRI scan, or neuropathology (Keenan et al., 2003) were eligible for the study. "
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    ABSTRACT: The behavioral ratings of preschoolers who sustained traumatic brain injury (TBI) prior to the age of 2 years and a typically developing group were compared; predictors of behavioral functioning were examined. Eighty-two 3-year-olds comprised mild TBI (n = 31), moderate/severe TBI (n = 20), and typically developing (n = 31) groups, with Child Behavior Checklist (CBCL) as the primary outcome measure. Groups differed on the CBCL Withdrawal Scale. No differences emerged in the proportion of children demonstrating clinical elevations, with average mean scores for each group. Exploratory analyses yielded no differences between inflicted, non-inflicted, and typical groups. Glasgow Coma Scale and Self-Report Family Inventory Leadership predicted Externalizing Problems; developmental level predicted Internalizing Problems. After early TBI, preschoolers did not differ from one another or a matched comparison group in behavioral ratings; however, it may be premature to infer that preschoolers do not evidence behavioral dysfunction after early TBI.
    Full-text · Article · Oct 2009 · Journal of Pediatric Psychology
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    • "Present intensive care management does not offer any neuroprotective therapies that have correlated with improved long-term outcome. Even after recovery, many children face significant neurologic sequelae, which potentially persist into adulthood (Hawley, 2003; Keenan et al., 2007). In an effort to minimize long-term morbidity , it is essential to understand the basic mechanisms occurring in the brain following injury. "
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    ABSTRACT: Although studies have shown alterations in cerebral metabolism after traumatic brain injury (TBI), clinical data in the developing brain is limited. We hypothesized that post-traumatic metabolic changes occur early (<24 h) and persist for up to 1 week. Immature rats underwent TBI to the left parietal cortex. Brains were removed at 4 h, 24 h, and 7 days after injury, and separated into ipsilateral (injured) and contralateral (control) hemispheres. Proton nuclear magnetic resonance (NMR) spectra were obtained, and spectra were analyzed for N-acetyl-aspartate (NAA), lactate (Lac), creatine (Cr), choline, and alanine, with metabolite ratios determined (NAA/Cr, Lac/Cr). There were no metabolic differences at any time in sham controls between cerebral hemispheres. At 4 and 24 h, there was an increase in Lac/Cr, reflecting increased glycolysis and/or decreased oxidative metabolism. At 24 h and 7 days, there was a decrease in NAA/Cr, indicating loss of neuronal integrity. The NAA/Lac ratio was decreased ( approximately 15-20%) at all times (4 h, 24 h, 7 days) in the injured hemisphere of TBI rats. In conclusion, metabolic derangements begin early (<24 h) after TBI in the immature rat and are sustained for up to 7 days. Evaluation of early metabolic alterations after TBI could identify novel targets for neuroprotection in the developing brain.
    Preview · Article · Jun 2008 · Journal of Neurotrauma
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