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Biomarkers in Moderate to Severe Pediatric Traumatic Brain Injury: A Review of the Literature. Pediatr Neurol 2022; 130:60-68. [PMID: 35364462 PMCID: PMC9038667 DOI: 10.1016/j.pediatrneurol.2022.03.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 03/10/2022] [Accepted: 03/11/2022] [Indexed: 11/21/2022]
Abstract
BACKGROUND Despite decades of research, outcomes in pediatric traumatic brain injury (pTBI) remain highly variable. Brain biofluid-specific biomarkers from pTBI patients may allow us to diagnose and prognosticate earlier and with a greater degree of accuracy than conventional methods. This manuscript reviews the evidence surrounding current brain-specific biomarkers in pTBI and assesses the temporal relationship between the natural history of the traumatic brain injury (TBI) and measured biomarker levels. METHODS A literature search was conducted in the Ovid, PubMed, MEDLINE, and Cochrane databases seeking relevant publications. The study selection and screening process were documented in a Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow diagram. Extraction forms included developmental stages of patients, type and biofluid source of biomarkers, brain injury type, and other relevant data. RESULTS The search strategy identified 443 articles, of which 150 examining the biomarkers of our interest were included. The references retrieved were examined thoroughly and discussed at length with a pediatric neurocritical care intensivist specializing in pTBI and a Ph.D. scientist with a high degree of involvement in TBI biomarker research, authoring a vast amount of literature in this field. CONCLUSIONS TBI biomarkers might serve as valuable tools in the diagnosis and prognosis of pTBI. However, while each biomarker has its advantages, they are not without limitations, and therefore, further research is critical in pTBI biomarkers.
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2
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Chronic foetal hypoxaemia does not cause elevation of serum markers of brain injury. Cardiol Young 2022; 32:732-737. [PMID: 34365994 DOI: 10.1017/s1047951121002894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVES The objective of this study was to investigate changes in serum biomarkers of acute brain injury, including white matter and astrocyte injury during chronic foetal hypoxaemia. We have previously shown histopathological changes in myelination and neuronal density in fetuses with chronic foetal hypoxaemia at a level consistent with CHD. METHODS Mid-gestation foetal sheep (110 ± 3 days gestation) were cannulated and attached to a pumpless, low-resistance oxygenator circuit, and incubated in a sterile fluid environment mimicking the intrauterine environment. Fetuses were maintained with an oxygen delivery of 20-25 ml/kg/min (normoxemia) or 14-16 ml/kg/min (hypoxaemia). Myelin Basic Protein and Glial Fibrillary Acidic Protein serum levels in the two groups were assessed by ELISA at baseline and at 7, 14, and 21 days of support. RESULTS Based on overlapping 95% confidence intervals, there were no statistically significant differences in either Myelin Basic Protein or Glial Fibrillary Acidic Protein serum levels between the normoxemic and hypoxemic groups, at any time point. No statistically significant correlations were observed between oxygen delivery and levels of Myelin Basic Protein and Glial Fibrillary Acidic Protein. CONCLUSION Chronic foetal hypoxaemia during mid-gestation is not associated with elevated serum levels of acute white matter (Myelin Basic Protein) or astrocyte injury (Glial Fibrillary Acidic Protein), in this model. In conjunction with our previously reported findings, our data support the hypothesis that the brain dysmaturity with impaired myelination found in fetuses with chronic hypoxaemia is caused by disruption of normal developmental pathways rather than by direct cellular injury.
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3
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Hordijk JA, Verbruggen SC, Buysse CM, Utens EM, Joosten KF, Dulfer K. Neurocognitive functioning and health-related quality of life of children after pediatric intensive care admission: a systematic review. Qual Life Res 2022; 31:2601-2614. [PMID: 35357629 PMCID: PMC9356943 DOI: 10.1007/s11136-022-03124-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2022] [Indexed: 11/28/2022]
Abstract
OBJECTIVE This study systematically reviewed recent findings on neurocognitive functioning and health-related quality of life (HRQoL) of children after pediatric intensive care unit admission (PICU). DATA SOURCES Electronic databases searched included Embase, Medline Ovid, Web of Science, Cochrane CENTRAL, and Google Scholar. The search was limited to studies published in the last five years (2015-2019). STUDY SELECTION Original studies assessing neurocognitive functioning or HRQoL in children who were previously admitted to the PICU were included in this systematic review. DATA EXTRACTION Of the 3649 identified studies, 299 met the inclusion criteria based on title abstract screening. After full-text screening, 75 articles were included in the qualitative data reviewing: 38 on neurocognitive functioning, 33 on HRQoL, and 4 on both outcomes. DATA SYNTHESIS Studies examining neurocognitive functioning found overall worse scores for general intellectual functioning, attention, processing speed, memory, and executive functioning. Studies investigating HRQoL found overall worse scores for both physical and psychosocial HRQoL. On the short term (≤ 12 months), most studies reported HRQoL impairments, whereas in some long-term studies HRQoL normalized. The effectiveness of the few intervention studies during and after PICU admission on long-term outcomes varied. CONCLUSIONS PICU survivors have lower scores for neurocognitive functioning and HRQoL than children from the general population. A structured follow-up program after a PICU admission is needed to identify those children and parents who are at risk. However, more research is needed into testing interventions in randomized controlled trials aiming on preventing or improving impairments in critically ill children during and after PICU admission.
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Affiliation(s)
- José A Hordijk
- Intensive Care, Department of Pediatrics and Pediatric Surgery, Erasmus MC - Sophia Children's Hospital, Dr. Molewaterplein 60, 3015 GJ, Rotterdam, The Netherlands
| | - Sascha C Verbruggen
- Intensive Care, Department of Pediatrics and Pediatric Surgery, Erasmus MC - Sophia Children's Hospital, Dr. Molewaterplein 60, 3015 GJ, Rotterdam, The Netherlands
| | - Corinne M Buysse
- Intensive Care, Department of Pediatrics and Pediatric Surgery, Erasmus MC - Sophia Children's Hospital, Dr. Molewaterplein 60, 3015 GJ, Rotterdam, The Netherlands
| | - Elisabeth M Utens
- Research Institute of Child Development and Education, University of Amsterdam, Nieuwe Achtergracht 127, 1018 WS, Amsterdam, The Netherlands.,Academic Center for Child Psychiatry the Bascule/Department of Child and Adolescent Psychiatry, Academic Medical Center, Rijksstraatweg 145, 1115 AP, Amsterdam, The Netherlands.,Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC - Sophia Children's Hospital, Wytemaweg 8, 3015 CN, Rotterdam, The Netherlands
| | - Koen F Joosten
- Intensive Care, Department of Pediatrics and Pediatric Surgery, Erasmus MC - Sophia Children's Hospital, Dr. Molewaterplein 60, 3015 GJ, Rotterdam, The Netherlands
| | - Karolijn Dulfer
- Intensive Care, Department of Pediatrics and Pediatric Surgery, Erasmus MC - Sophia Children's Hospital, Dr. Molewaterplein 60, 3015 GJ, Rotterdam, The Netherlands.
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4
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Stojanovski S, Scratch SE, Dunkley BT, Schachar R, Wheeler AL. A Systematic Scoping Review of New Attention Problems Following Traumatic Brain Injury in Children. Front Neurol 2021; 12:751736. [PMID: 34858314 PMCID: PMC8631327 DOI: 10.3389/fneur.2021.751736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Accepted: 10/04/2021] [Indexed: 11/18/2022] Open
Abstract
Objective: To summarize existing knowledge about the characteristics of attention problems secondary to traumatic brain injuries (TBI) of all severities in children. Methods: Computerized databases PubMed and PsychINFO and gray literature sources were used to identify relevant studies. Search terms were selected to identify original research examining new ADHD diagnosis or attention problems after TBI in children. Studies were included if they investigated any severity of TBI, assessed attention or ADHD after brain injury, investigated children as a primary or sub-analysis, and controlled for or excluded participants with preinjury ADHD or attention problems. Results: Thirty-nine studies were included in the review. Studies examined the prevalence of and risk factors for new attention problems and ADHD following TBI in children as well as behavioral and neuropsychological factors associated with these attention problems. Studies report a wide range of prevalence rates of new ADHD diagnosis or attention problems after TBI. Evidence indicates that more severe injury, injury in early childhood, or preinjury adaptive functioning problems, increases the risk for new ADHD and attention problems after TBI and both sexes appear to be equally vulnerable. Further, literature suggests that cases of new ADHD often co-occurs with neuropsychiatric impairment in other domains. Identified gaps in our understanding of new attention problems and ADHD include if mild TBI, the most common type of injury, increases risk and what brain abnormalities are associated with the emergence of these problems. Conclusion: This scoping review describes existing studies of new attention problems and ADHD following TBI in children and highlights important risk factors and comorbidities. Important future research directions are identified that will inform the extent of this outcome across TBI severities, its neural basis and points of intervention to minimize its impact.
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Affiliation(s)
- Sonja Stojanovski
- SickKids Research Institute, Program in Neuroscience and Mental Health, Hospital for Sick Children, Neuroscience and Mental Health Program, Toronto, ON, Canada.,Physiology Department, University of Toronto, Toronto, ON, Canada
| | - Shannon E Scratch
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON, Canada.,Rehabilitation Sciences Institute, University of Toronto, Toronto, ON, Canada.,Department of Paediatrics, University of Toronto, Toronto, ON, Canada
| | - Benjamin T Dunkley
- SickKids Research Institute, Program in Neuroscience and Mental Health, Hospital for Sick Children, Neuroscience and Mental Health Program, Toronto, ON, Canada.,Institute of Medical Science, University of Toronto, Toronto, ON, Canada.,Medical Imaging, University of Toronto, Toronto, ON, Canada
| | - Russell Schachar
- SickKids Research Institute, Program in Neuroscience and Mental Health, Hospital for Sick Children, Neuroscience and Mental Health Program, Toronto, ON, Canada.,Psychiatry Department, University of Toronto, Toronto, ON, Canada
| | - Anne L Wheeler
- SickKids Research Institute, Program in Neuroscience and Mental Health, Hospital for Sick Children, Neuroscience and Mental Health Program, Toronto, ON, Canada.,Physiology Department, University of Toronto, Toronto, ON, Canada
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5
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Ganeshalingham A, Beca J. Serum biomarkers in severe paediatric traumatic brain injury-a narrative review. Transl Pediatr 2021; 10:2720-2737. [PMID: 34765496 PMCID: PMC8578762 DOI: 10.21037/tp-20-386] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/13/2020] [Accepted: 05/14/2021] [Indexed: 11/22/2022] Open
Abstract
Severe traumatic brain injury continues to present complex management and prediction challenges for the clinician. While there is some evidence that better systems of care can improve outcome, multiple multi-centre randomised controlled trials of specific therapies have consistently failed to show benefit. In addition, clinicians are challenged in attempting to accurately predict which children will recover well and which children will have severe and persisting neurocognitive deficits. Traumatic brain injury is vastly heterogeneous and so it is not surprising that one therapy or approach, when applied to a mixed cohort of children in a clinical trial setting, has yielded disappointing results. Children with severe traumatic brain injury have vastly different brain injury pathologies of widely varying severity, in any number of anatomical locations at what may be disparate stages of brain development. This heterogeneity may also explain why clinicians are unable to accurately predict outcome. Biomarkers are objective molecular signatures of injury that are released following traumatic brain injury and may represent a way of unifying the heterogeneity of traumatic brain injury into a single biosignature. Biomarkers hold promise to diagnose brain injury severity, guide intervention selection for clinical trials, or provide vital prognostic information so that early intervention and rehabilitation can be planned much earlier in the course of a child's recovery. Serum S100B and serum NSE levels show promise as a diagnostic tool with biomarker levels significantly higher in children with severe TBI including children with inflicted and non-inflicted head injury. Serum S100B and serum NSE also show promise as a predictor of neurodevelopmental outcome. The role of biomarkers in traumatic brain injury is an evolving field with the potential for clinical application within the next few years.
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Affiliation(s)
| | - John Beca
- Paediatric Intensive Care Unit, Starship Children's Hospital, Auckland, New Zealand
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6
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McInnis C, Garcia MJS, Widjaja E, Frndova H, Huyse JV, Guerguerian AM, Oyefiade A, Laughlin S, Raybaud C, Miller E, Tay K, Bigler ED, Dennis M, Fraser DD, Campbell C, Choong K, Dhanani S, Lacroix J, Farrell C, Beauchamp MH, Schachar R, Hutchison JS, Wheeler AL. Magnetic Resonance Imaging Findings Are Associated with Long-Term Global Neurological Function or Death after Traumatic Brain Injury in Critically Ill Children. J Neurotrauma 2021; 38:2407-2418. [PMID: 33787327 DOI: 10.1089/neu.2020.7514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The identification of children with traumatic brain injury (TBI) who are at risk of death or poor global neurological functional outcome remains a challenge. Magnetic resonance imaging (MRI) can detect several brain pathologies that are a result of TBI; however, the types and locations of pathology that are the most predictive remain to be determined. Forty-two critically ill children with TBI were recruited prospectively from pediatric intensive care units at five Canadian children's hospitals. Pathologies detected on subacute phase MRIs included cerebral hematoma, herniation, cerebral laceration, cerebral edema, midline shift, and the presence and location of cerebral contusion or diffuse axonal injury (DAI) in 28 regions of interest were assessed. Global functional outcome or death more than 12 months post-injury was assessed using the Pediatric Cerebral Performance Category score. Linear modeling was employed to evaluate the utility of an MRI composite score for predicting long-term global neurological function or death after injury, and nonlinear Random Forest modeling was used to identify which MRI features have the most predictive utility. A linear predictive model of favorable versus unfavorable long-term outcomes was significantly improved when an MRI composite score was added to clinical variables. Nonlinear Random Forest modeling identified five MRI variables as stable predictors of poor outcomes: presence of herniation, DAI in the parietal lobe, DAI in the subcortical white matter, DAI in the posterior corpus callosum, and cerebral contusion in the anterior temporal lobe. Clinical MRI has prognostic value to identify children with TBI at risk of long-term unfavorable outcomes.
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Affiliation(s)
- Carter McInnis
- Faculty of Health Sciences, Queen's University, Kingston, Ontario, Canada
- Neuroscience and Mental Health Research Program, Hospital for Sick Children, Toronto, Ontario, Canada
| | - María José Solana Garcia
- Neuroscience and Mental Health Research Program, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Elysa Widjaja
- Neuroscience and Mental Health Research Program, Hospital for Sick Children, Toronto, Ontario, Canada
- Division of Neuroradiology, Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Helena Frndova
- Department of Critical Care Medicine, and Hospital for Sick Children, Toronto, Ontario, Canada
| | - Judith Van Huyse
- Neuroscience and Mental Health Research Program, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Anne-Marie Guerguerian
- Neuroscience and Mental Health Research Program, Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Critical Care Medicine, and Hospital for Sick Children, Toronto, Ontario, Canada
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
- Interdepartmental Division of Critical Care, University of Toronto, Toronto, Ontario, Canada
| | - Adeoye Oyefiade
- Neuroscience and Mental Health Research Program, Hospital for Sick Children, Toronto, Ontario, Canada
- Division of Hematology/Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Suzanne Laughlin
- Division of Neuroradiology, Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Medical Imaging, and Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Charles Raybaud
- Division of Neuroradiology, Department of Diagnostic Imaging, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Elka Miller
- Department of Medical Imaging, and Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Keng Tay
- Department of Radiology, London Health Sciences Centre, London, Ontario, Canada
| | - Erin D Bigler
- Department of Psychological Science and Neuroscience Centre, Brigham Young University, Provo, Utah, USA
| | - Maureen Dennis
- Neuroscience and Mental Health Research Program, Hospital for Sick Children, Toronto, Ontario, Canada
- Division of Hematology/Oncology, University of Toronto, Toronto, Ontario, Canada
- Department of Surgery, and University of Toronto, Toronto, Ontario, Canada
| | - Douglas D Fraser
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Schulich School of Medicine University of Western Ontario, Children's Hospital of the London Health Sciences Centre and the Lawson Research Institute, London, Ontario, Canada
| | - Craig Campbell
- Division of Neurology, Children's Hospital of the London Health Sciences Centre and Department of Pediatrics, Epidemiology and Clinical Neurological Sciences, Schulich School of Medicine, University of Western Ontario, London, Ontario, Canada
| | - Karen Choong
- Division of Pediatric Intensive Care, Department of Pediatrics, McMaster Children's Hospital-Hamilton Health Sciences, Hamilton, Ontario, Canada
| | - Sonny Dhanani
- Division of Pediatric Intensive Care, Department of Pediatrics, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Jacques Lacroix
- Division of Pediatric Critical Care, CHU Sainte-Justine, Université de Montréal and Centre de Recherche du CHU Sainte-Justine, Montreal, Quebec, Canada
| | - Catherine Farrell
- Division of Pediatric Critical Care, CHU Sainte-Justine, Université de Montréal and Centre de Recherche du CHU Sainte-Justine, Montreal, Quebec, Canada
| | - Miriam H Beauchamp
- Division of Pediatric Critical Care, CHU Sainte-Justine, Université de Montréal and Centre de Recherche du CHU Sainte-Justine, Montreal, Quebec, Canada
- Department of Psychology, Université de Montréal, Montreal, Quebec, Canada
| | - Russell Schachar
- Neuroscience and Mental Health Research Program, Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Psychiatry, Hospital for Sick Children, Toronto, Ontario, Canada
| | - James S Hutchison
- Neuroscience and Mental Health Research Program, Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Critical Care Medicine, and Hospital for Sick Children, Toronto, Ontario, Canada
- Institute of Medical Science, University of Toronto, Toronto, Ontario, Canada
- Interdepartmental Division of Critical Care, University of Toronto, Toronto, Ontario, Canada
| | - Anne L Wheeler
- Neuroscience and Mental Health Research Program, Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Physiology, University of Toronto, Toronto, Ontario, Canada
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7
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Traumatic brain injury biomarkers in pediatric patients: a systematic review. Neurosurg Rev 2021; 45:167-197. [PMID: 34170424 DOI: 10.1007/s10143-021-01588-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 05/23/2021] [Accepted: 06/15/2021] [Indexed: 10/21/2022]
Abstract
Traumatic brain injury (TBI) is the main cause of pediatric trauma death and disability worldwide. Recent studies have sought to identify biomarkers of TBI for the purpose of assessing functional outcomes. The aim of this systematic review was to evaluate the utility of TBI biomarkers in the pediatric population by summarizing recent findings in the medical literature. A total of 303 articles were retrieved from our search. An initial screening to remove duplicate studies yielded 162 articles. After excluding all articles that did not meet the inclusion criteria, 56 studies were gathered. Among the 56 studies, 36 analyzed serum biomarkers; 11, neuroimaging biomarkers; and 9, cerebrospinal fluid (CSF) biomarkers. Most studies assessed biomarkers in the serum, reflecting the feasibility of obtaining blood samples compared to obtaining CSF or performing neuroimaging. S100B was the most studied serum biomarker in TBI, followed by SNE and UCH-L1, whereas in CSF analysis, there was no unanimity. Among the different neuroimaging techniques employed, diffusion tensor imaging (DTI) was the most common, seemingly holding diagnostic power in the pediatric TBI clinical setting. The number of cross-sectional studies was similar to the number of longitudinal studies. Our data suggest that S100B measurement has high sensitivity and great promise in diagnosing pediatric TBI, ideally when associated with head CT examination and clinical decision protocols. Further large-scale longitudinal studies addressing TBI biomarkers in children are required to establish more accurate diagnostic protocols and prognostic tools.
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8
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Crichton A, Ignjatovic V, Babl FE, Oakley E, Greenham M, Hearps S, Delzoppo C, Beauchamp MH, Guerguerian AM, Boutis K, Hubara E, Hutchison J, Anderson V. Interleukin-8 Predicts Fatigue at 12 Months Post-Injury in Children with Traumatic Brain Injury. J Neurotrauma 2021; 38:1151-1163. [PMID: 31880977 DOI: 10.1089/neu.2018.6083] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Despite many children experiencing fatigue after childhood brain injury, little is known about the predictors of this complaint. To date, traditional indices of traumatic brain injury (TBI) severity have not predicted reliably persisting fatigue (up to three years post-injury). This study aimed to establish whether persisting fatigue is predicted by serum biomarker concentrations in child TBI. We examined whether acute serum biomarker expression would improve prediction models of 12-month fatigue based on injury severity. Blood samples were collected from 87 children (1-17 years at injury) sustaining mild to severe TBI (Glasgow Coma Scale [GCS] range 3-15; mean 12.43; classified as mild TBI [n = 50, 57%] vs. moderate/severe TBI [n = 37, 43%]), and presenting to the emergency departments (ED) and pediatric intensive care units (PICU) at one of three tertiary pediatric hospitals (Royal Children's Hospital (RCH); Hospital for Sick Children (HSC), Toronto; St Justine Children's Hospital (SJH), Montreal). Six serum biomarker concentrations were measured within 24 h of injury (interleukin-6, interleukin-8 [IL-8], soluble vascular cell adhesion molecule [SVCAM], S100 calcium binding protein B [S100B], neuron specific enolase [NSE], and soluble neural cell adhesion molecule [sNCAM]). Fatigue at 12 months post-injury was measured using the Pediatric Quality of Life Inventory Multidimensional Fatigue Scale (parent report), classified as present/absent using previously derived cut-points. At 12 months post-injury, 22% of participants experienced fatigue. A model including IL-8 was the best serum biomarker for estimating the probability of children experiencing fatigue at 12 months post-injury. The IL-8 also significantly improved predictive models of fatigue based on severity.
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Affiliation(s)
- Alison Crichton
- Murdoch Children's Research Institute, Melbourne, Australia.,Monash University Faculty of Medicine Nursing and Health Sciences, School of Clinical Sciences, The Department of Paediatrics, School of Clinical Sciences, Monash University, Melbourne, Australia
| | - Vera Ignjatovic
- Murdoch Children's Research Institute, Melbourne, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia
| | - Franz E Babl
- Murdoch Children's Research Institute, Melbourne, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia.,Royal Children's Hospital, Melbourne, Australia
| | - Ed Oakley
- Murdoch Children's Research Institute, Melbourne, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Australia.,Royal Children's Hospital, Melbourne, Australia
| | - Mardee Greenham
- Murdoch Children's Research Institute, Melbourne, Australia.,School of Psychological Sciences, University of Melbourne, Melbourne, Australia
| | - Stephen Hearps
- Murdoch Children's Research Institute, Melbourne, Australia
| | - Carmel Delzoppo
- Murdoch Children's Research Institute, Melbourne, Australia.,Royal Children's Hospital, Melbourne, Australia
| | - Miriam H Beauchamp
- Department of Psychology, University of Montreal, Montreal, Canada.,Research Center, Ste-Justine Hospital, Montreal, Canada
| | - Anne-Marie Guerguerian
- Critical Care Medicine, The Hospital for Sick Children (SickKids), Toronto, Canada.,Neuroscience and Mental Health Research Program, The Hospital for Sick Children Research Institute, Toronto, Canada.,The Interdepartmental Division of Critical Care, University of Toronto, Toronto, Canada
| | - Kathy Boutis
- Paediatric Emergency Medicine, The Hospital for Sick Children (SickKids), Toronto, Canada.,Department of Paediatrics, University of Toronto, Toronto, Canada
| | - Evyatar Hubara
- Critical Care Medicine, The Hospital for Sick Children (SickKids), Toronto, Canada
| | - Jamie Hutchison
- Critical Care Medicine, The Hospital for Sick Children (SickKids), Toronto, Canada.,Neuroscience and Mental Health Research Program, The Hospital for Sick Children Research Institute, Toronto, Canada.,The Interdepartmental Division of Critical Care, University of Toronto, Toronto, Canada
| | - Vicki Anderson
- Murdoch Children's Research Institute, Melbourne, Australia.,School of Psychological Sciences, University of Melbourne, Melbourne, Australia.,Royal Children's Hospital, Melbourne, Australia
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9
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Biopsychosocial Factors Associated With Attention Problems in Children After Traumatic Brain Injury. Am J Phys Med Rehabil 2020; 100:215-228. [DOI: 10.1097/phm.0000000000001643] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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10
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Shores DR, Everett AD. Children as Biomarker Orphans: Progress in the Field of Pediatric Biomarkers. J Pediatr 2018; 193:14-20.e31. [PMID: 29031860 PMCID: PMC5794519 DOI: 10.1016/j.jpeds.2017.08.077] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2017] [Revised: 08/04/2017] [Accepted: 08/30/2017] [Indexed: 12/20/2022]
Affiliation(s)
- Darla R Shores
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD.
| | - Allen D Everett
- Division of Cardiology, Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD
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11
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Wilkinson AA, Dennis M, Simic N, Taylor MJ, Morgan BR, Frndova H, Choong K, Campbell C, Fraser D, Anderson V, Guerguerian AM, Schachar R, Hutchison J. Brain biomarkers and pre-injury cognition are associated with long-term cognitive outcome in children with traumatic brain injury. BMC Pediatr 2017; 17:173. [PMID: 28738850 PMCID: PMC5525296 DOI: 10.1186/s12887-017-0925-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 07/10/2017] [Indexed: 11/19/2022] Open
Abstract
Background Children with traumatic brain injury (TBI) are frequently at risk of long-term impairments of attention and executive functioning but these problems are difficult to predict. Although deficits have been reported to vary with injury severity, age at injury and sex, prognostication of outcome remains imperfect at a patient-specific level. The objective of this proof of principle study was to evaluate a variety of patient variables, along with six brain-specific and inflammatory serum protein biomarkers, as predictors of long-term cognitive outcome following paediatric TBI. Method Outcome was assessed in 23 patients via parent-rated questionnaires related to attention deficit hyperactivity disorder (ADHD) and executive functioning, using the Conners 3rd Edition Rating Scales (Conners-3) and Behaviour Rating Inventory of Executive Function (BRIEF) at a mean time since injury of 3.1 years. Partial least squares (PLS) analyses were performed to identify factors measured at the time of injury that were most closely associated with outcome on (1) the Conners-3 and (2) the Behavioural Regulation Index (BRI) and (3) Metacognition Index (MI) of the BRIEF. Results Higher levels of neuron specific enolase (NSE) and lower levels of soluble neuron cell adhesion molecule (sNCAM) were associated with higher scores on the inattention, hyperactivity/impulsivity and executive functioning scales of the Conners-3, as well as working memory and initiate scales of the MI from the BRIEF. Higher levels of NSE only were associated with higher scores on the inhibit scale of the BRI. Conclusions NSE and sNCAM show promise as reliable, early predictors of long-term attention-related and executive functioning problems following paediatric TBI.
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Affiliation(s)
- Amy A Wilkinson
- Department of Psychology, University of Toronto, Toronto, Canada. .,Program in Neuroscience & Mental Health, The Hospital for Sick Children, Toronto, Canada.
| | - Maureen Dennis
- Department of Psychology, University of Toronto, Toronto, Canada.,Program in Neuroscience & Mental Health, The Hospital for Sick Children, Toronto, Canada.,Department of Surgery, University of Toronto, Toronto, Canada
| | - Nevena Simic
- Comprehensive Pediatric Epilepsy Program, Hamilton Health Sciences Corporation, Hamilton, Canada
| | - Margot J Taylor
- Department of Psychology, University of Toronto, Toronto, Canada.,Program in Neuroscience & Mental Health, The Hospital for Sick Children, Toronto, Canada.,Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Canada
| | - Benjamin R Morgan
- Department of Diagnostic Imaging, The Hospital for Sick Children, Toronto, Canada
| | - Helena Frndova
- Department of Critical Care Medicine, The Hospital for Sick Children, Toronto, Canada
| | - Karen Choong
- Division of Pediatric Intensive Care, Department of Pediatrics, Children's Hospital of Hamilton, Hamilton, Canada
| | - Craig Campbell
- Pediatrics, Clinical Neurological Sciences and Epidemiology, Schulich School of Medicine, Western University, London, Canada
| | - Douglas Fraser
- Pediatrics, Clinical Neurological Sciences and Epidemiology, Schulich School of Medicine, Western University, London, Canada
| | - Vicki Anderson
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Australia.,Psychological Sciences and Pediatrics, University of Melbourne, Melbourne, Australia
| | - Anne-Marie Guerguerian
- Program in Neuroscience & Mental Health, The Hospital for Sick Children, Toronto, Canada.,Department of Critical Care Medicine, The Hospital for Sick Children, Toronto, Canada
| | - Russell Schachar
- Program in Neuroscience & Mental Health, The Hospital for Sick Children, Toronto, Canada.,Department of Psychiatry, The Hospital for Sick Children, Toronto, Canada
| | - Jamie Hutchison
- Program in Neuroscience & Mental Health, The Hospital for Sick Children, Toronto, Canada. .,Department of Critical Care Medicine, The Hospital for Sick Children, Toronto, Canada.
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Nakhjavan-Shahraki B, Yousefifard M, Oraii A, Sarveazad A, Hosseini M. Meta-analysis of neuron specific enolase in predicting pediatric brain injury outcomes. EXCLI JOURNAL 2017; 16:995-1008. [PMID: 28900380 PMCID: PMC5579403 DOI: 10.17179/excli2017-405] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Accepted: 06/12/2017] [Indexed: 12/28/2022]
Abstract
A reliable biomarker has not been identified to predict the outcome of traumatic brain injury (TBI) in children. Therefore, the present systematic review and meta-analysis aimed to assess the association between neuron specific enolase (NSE) and traumatic brain injury (TBI) in children. Two independent reviewers searched electronic databases of EMBASE, Cochrane library, Medline and Scopus and then they summarized the results and did a quality control check. At the end, standardized mean difference (SMD) with 95 % confidence interval (CI) and performance of NSE were assessed. 10 studies were included in the present meta-analysis. Average serum (SMD=1.3; 95 % CI: 0.5 to 2.1; p=0.001) and CSF levels (SMD=2.45; 95 % CI: 1.04 to 3.8; p<0.0001) of NSE biomarker were significantly higher in children with TBI with unfavorable outcome compared with other children. Serum NSE had an area under the curve, sensitivity and specificity of 0.75 (95 % CI: 0.72 to 0.79), 0.74 (95 % CI: 0.64 to 0.82) and 0.69 (95 % CI: 0.59 to 0.77), respectively in prediction outcome of TBI. Positive likelihood ratio, negative likelihood ratio and diagnostic odds ratio of serum NSE were 2.4 (95 % CI: 1.7 to 3.3), 0.38 (95 % CI: 0.26 to 0.55) and 6.0 (95 % CI: 3.0 to 12.0), respectively. The results show that the performance of NSE is in a moderate level in prediction of unfavorable outcome in children with TBI. However, data in this aspect is not sufficient and more studies are needed.
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Affiliation(s)
| | - Mahmoud Yousefifard
- Physiology Research Center and Department of Physiology, Faculty of Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Alireza Oraii
- Department of Medicine, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Arash Sarveazad
- Colorectal Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Mostafa Hosseini
- Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
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Translating biomarkers from research to clinical use in pediatric neurocritical care: focus on traumatic brain injury and cardiac arrest. Curr Opin Pediatr 2017; 29:272-279. [PMID: 28319562 DOI: 10.1097/mop.0000000000000488] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
PURPOSE OF REVIEW Traumatic brain injury (TBI) and cardiac arrest are important causes of morbidity and mortality in children. Improved diagnosis and outcome prognostication using validated biomarkers could allow clinicians to better tailor therapies for optimal efficacy. RECENT FINDINGS Contemporary investigation has yielded plentiful biomarker candidates of central nervous system (CNS) injury, including macromolecules, genetic, inflammatory, oxidative, and metabolic biomarkers. Biomarkers have yet to be validated and translated into bedside point-of-care or cost-effective and efficient laboratory tests. Validation testing should consider developmental status, injury mechanism, and time trajectory with patient-centered outcomes. SUMMARY Recent investigation of biomarkers of CNS injury may soon improve diagnosis, management, and prognostication in children with traumatic brain injury and cardiac arrest.
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The intensive care medicine clinical research agenda in paediatrics. Intensive Care Med 2017; 43:1210-1224. [PMID: 28315043 DOI: 10.1007/s00134-017-4729-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Accepted: 02/16/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND Intensive Care Medicine set us the task of outlining a global clinical research agenda for paediatric intensive care (PIC). In line with the clinical focus of this journal, we have limited this to research that may directly influence patient care. METHODS Clinician researchers from PIC research networks of varying degrees of formality from around the world were invited to answer two main questions: (1) What have been the major recent advances in paediatric critical care research? (2) What are the top 10 studies for the next 10 years? RESULTS (1) Inclusive databases are well established in many countries. These registries allow detailed observational studies and feasibility testing of clinical trial protocols. Recent trials are larger and more valuable, and (2) most common interventions in PIC are not evidenced-based. Clinical studies for the next 10 years should address this deficit, including: ventilation techniques and interfaces; fluid, transfusion and feeding strategies; optimal targets for vital signs; multiple organ failure definitions, mechanisms and treatments; trauma, prevention and treatment; improving safety; comfort of the patient and their family; appropriate care in the face of medical complexity; defining post-PICU outcomes; and improving knowledge generation and adoption, with novel trial design and implementation strategies. The group specifically highlighted the need for research in resource-limited environments wherein mortality remains often tenfold higher than in well-resourced settings. CONCLUSION Paediatric intensive care research has never been healthier, but many gaps in knowledge remain. We need to close these urgently. The impact of new knowledge will be greatest in resource-limited environments.
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