Overcoming Challenges in the Determination of Death by Neurologic Criteria in Pediatric Patients

Abstract

In the United States, the declaration of death by neurologic criteria in infants and children is clinically determined by standards published in 2011 by a multidisciplinary committee from the Society of Critical Care Medicine, the American Academy of Pediatrics, and the Child Neurology Society. These standards recognize that developmental differences in infants and children impact the neurologic evaluation for determination of death by neurologic criteria and justify a pediatric-specific approach. Approximately 20% of children who die in pediatric intensive care units are declared dead using neurologic criteria. There is marked variability in institutional standards for the determination of death by neurologic criteria, particularly with respect to prerequisites, apnea testing, and ancillary testing. In this chapter, we review how to overcome challenges in the pediatric death by neurologic criteria evaluation, including how to exclude confounders, perform the neurologic examination, conduct the apnea test, and when to consider ancillary testing. We briefly discuss objections to determination of death by neurologic criteria in children and address how to talk to families about death by neurologic criteria.