Seminars in pediatric neurology
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Semin Pediatr Neurol · Mar 1999
ReviewThe pursuit of effective neuroprotection during infant cardiac surgery.
Advances in infant cardiac surgery have resulted in a dramatic decline in mortality rates; however, neurological morbidity remains an important concern. The effectiveness of a number of interventional strategies to prevent or minimize brain injury during open heart surgery are currently being investigated. This article provides an overview of two approaches: (1) interventions to enhance intraoperative cerebral oxygenation so as to prevent hypoxic-ischemic insults, and (2) the application of cerebral rescue therapies to attenuate the cascade of brain injury. Infant cardiac surgery provides a controlled environment in which to apply these neuroprotective approaches, so as to optimize the quality of life of these vulnerable children.
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Neurological injury is a major and often debilitating complication of congenital heart disease and open-heart surgery. Paradoxically, the full impact of this complication has been underscored by the marked decrease in mortality and the rescue of infants with desperate and previously lethal heart conditions. ⋯ Inflammatory cascades have been implicated in the end-organ injury seen after cardiopulmonary bypass and might play a role in neurological dysfunction. These mechanisms are reviewed, with an emphasis on recent developments in our understanding of brain injury in this population.
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Semin Pediatr Neurol · Mar 1998
ReviewBenefits of early intervention for children with developmental disabilities.
Early intervention programs are designed to enhance the developmental competence of participants and to prevent or minimize developmental delays. Children targeted for early intervention may either include environmentally or biologically vulnerable children, or those with established developmental deficits. ⋯ However, this literature is limited by substantial methodological weaknesses in most studies. Therefore further randomized clinical trials are needed to ascertain which programs best meet the needs of children with or at risk for developmental disability.
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Pediatric central nervous system neoplasms include a spectrum of both glial and nonglial tumors that differ significantly in location and biological behavior from those of adults. Brain tumors in infants and children most often arise from central neuroepithelial tissue, whereas a significant number of adult tumors arise from central nervous system coverings (e.g., meningioma), adjacent tissue (e.g., pituitary adenoma), or metastases. ⋯ Entities, such as the brainstem glioma, and less common neoplasms like the desmoplastic infantile ganglioglioma and the central nervous system atypical teratoid/rhabdoid tumor are reviewed because they occur almost exclusively in children. Known cytogenetic and molecular characteristics of childhood brain tumors are also reviewed.
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Semin Pediatr Neurol · Sep 1997
ReviewIntracranial pressure: current status in monitoring and management.
One of the most frequently occurring questions in the neurological critical care of children involves the indications for measurement of intracranial pressure (ICP) and the appropriate therapies for abnormally elevated ICP. Advances in monitoring technology have improved the safety and accuracy of ICP measurement. ⋯ For several diseases, the ability to measure and manage ICP has resulted in marked improvements in outcomes. This article reviews the indications for, and recommended methods of, measuring ICP in children and discusses the status of therapies commonly used to control elevated ICP.