The most common causes of brain death in children are
- Trauma
- Anoxic encephalopathy
- Infections
- Cerebral neoplasms
Age and brain death certification for the UK
- Children > 2 months the criteria used to establish death should be the same as those in adults
- Between 37 weeks of gestation and 2 months of age
- it is rarely possible confidently to diagnose death as a result of cessation of brainstem reflexes,
- < 37 weeks of gestation
- the criteria to establish brainstem death with brainstem reflexes is not reliable.
Several specific recommendations made by the American Academy of Pediatrics in 2011.
- These guidelines are based in large part on consensus opinion as evidence is limited
- Waiting period before initial brain death examination
- 24 h following cardiopulmonary resuscitation or severe acute brain injury is suggested if there are concerns about the neurologic examination or if dictated by clinical judgment.
Clinical examination | Required |
Core body temperature | >35 °C (95 °F) |
Number of examinations | Two (different attending physicians must perform the first and second exam) |
Observation interval between neurologic examinations | Age dependent Term newborn (37 weeks' gestation) to 30 days of age: 24 h 31 days to 18 years: 12 h |
Reduction of observation period between exams | Permitted for both age groups if EEG or CBF consistent with brain death |
Apnea testing | Two apnea tests required unless clinically contraindicated |
Final PCO2 threshold for apnea testing | >60 mmHg and >20 mmHg above the baseline PCO2 |
Ancillary study recommended | Not required except in cases where the clinical examination and apnea test cannot be completed • Term newborn (37 weeks' gestation) to 30 days of age: EEG or CBF are preferred. • >30 days to 18 years: EEG and CBF have equal sensitivity |
Time of death | Time of the second examination and apnea test (or completion of ancillary study and the components of the second examination that can be safely completed) |
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