Traumatic Brain Injury In Children Research Articles

Family Functioning and Child Participation Following Early Childhood Traumatic Brain Injury

Family functioning and child participation are critical factors in recovery from traumatic brain injury (TBI) and academic and social outcomes. Using mixed methods, we investigated these factors in children who experienced early childhood TBIs and then entered formal schooling. Caregivers completed interviews and scales of family functioning and child participation. Their scores did not reflect problematic family functioning, but showed participation across settings was below average. Themes from interviews included: (1) early childhood TBIs can affect family functioning even years after the injury; (2) learning, academic, and social-emotional issues impact participation and family functioning following early childhood TBI; and (3) appropriate supports and accessible environments are critical for both family functioning and child participation across settings. Mixed methods analyses indicated convergence, divergence, and expansion between qualitative and quantitative results. Results enhance our understanding of challenges encountered after early childhood TBI and provide directions for future interventions.

A short scale to measure health-related quality of life after traumatic brain injury in children and adolescents (QOLIBRI-OS-KID/ADO): psychometric properties and German reference values

PurposeThe impact of pediatric traumatic brain injury (pTBI) on health-related quality of life (HRQoL) in children and adolescents remains understudied. Short scales have some advantages in terms of economy and administration over longer scales, especially in younger children. The aim of the present study is to psychometrically evaluate the six-item German version of the QOLIBRI-OS-KID/ADO scale for children and adolescents. In addition, reference values from a general German pediatric population are obtained to assist clinicians and researchers in the interpretation of HRQoL after pTBI.MethodsA total of 297 individuals after TBI and 1997 from a general population sample completed the questionnaire. Reliability, validity, and comparability of the assessed construct were examined.ResultsThe questionnaire showed satisfactory reliability (α = 0.75 and ω = 0.81 and α = 0.85 and ω = 0.86 for the TBI and general population samples, respectively). The QOLIBRI-OS-KID/ADO was highly correlated with its long version (R2 = 67%) and showed an overlap with disease-specific HRQoL (R2 = 55%) in the TBI sample. The one-dimensional factorial structure could be replicated and tested for measurement invariance between samples, indicating a comparable HRQoL construct assessment. Therefore, reference values and cut-offs indicating clinically relevant impairment could be provided using percentiles stratified by factors significantly associated with the total score in the regression analyses (i.e., age group and gender).ConclusionIn combination with the cut-offs, the QOLIBRI-OS-KID/ADO provides a cost-effective screening tool, complemented by interpretation guidelines, which may help to draw clinical conclusions and indications such as further administration of a longer version of the instrument to gain more detailed insight into impaired HRQoL domains or omission of further steps in the absence of an indication.

Posterior Reversible Encephalopathy Syndrome in a child after Severe Traumatic Brain Injury

Pediatric brain is anatomically and physiologically different from adult brain. Child's brain is more vulnerable to the effects of a brain injury and takes longer to recover. Because the child’s brain is still developing, injury may alter the course of development of the brain and its functions. The child's brain is less "set" than the adult's, its plasticity offers hope to damaged tissue and areas. It is very rare to have posterior reversible encephalopathy syndrome as a complication of traumatic brain injury in children.

Fatigue, Fogginess, and Sleep Complaints: Presence and Impact on Functioning After Childhood Traumatic Brain Injury.

The purpose of this study was to examine the occurrence and impact of fatigue, fogginess, and sleep complaints on functioning at 3, 6, 10, and 16 months after childhood traumatic brain injury (TBI). Eighty-eight caregivers completed online surveys regarding their children with TBI, with 17 participants included at the final time point. Measures included questions related to demographic and injury characteristics, executive functioning, social relations, health-related quality of life, and fatigue, fogginess, and sleep complaints. Fatigue, fogginess, and sleep complaints were persistent and ultimately increased at 16 months postinjury. Over half of the participants were experiencing each symptom at 16 months postinjury (i.e., 52.94% fatigue and fogginess, 58.82% sleep complaints). At 16 months postinjury, fatigue was significantly associated with female sex, and fatigue and sleep complaints were significantly associated with lower physical quality of life, but no other differences were found with symptoms and current functioning. The results of this study support that fatigue, fogginess, and sleep complaints can persist (from baseline, from postinjury, and in fluctuation) chronically for about half of the children with TBI but little association or impact on other domains of functioning. The present study supports the continued investigation of fatigue, fogginess, and sleep complaints after childhood brain injury, but further investigation with a larger sample size is necessary to inform clinical practices for assessment and management, particularly for speech-language pathologists in rehabilitation and educational settings.

Primary caregiver employment status is associated with traumatic brain injury in children in the USA

BackgroundTraumatic brain injury (TBI) is a common injury in children. Previous literature has demonstrated that TBI may be associated with supervision level. We hypothesised that primary caregiver employment would be...

Traumatic Brain Injury in Children: A Comprehensive Study of Epidemiology, Treatment, and Outcomes in Guntur, Andhra Pradesh

Traumatic Brain Injury in Children: A Comprehensive Study of Epidemiology, Treatment, and Outcomes in Guntur, Andhra Pradesh

Rehabilitation of Executive Function in Pediatric Traumatic Brain Injury (REPeaT): Outcomes of a pilot randomized controlled trial.

To evaluate the effectiveness of Cogmed Working Memory Training (Cogmed) in improving working memory (WM) and decision making (DM) in childhood traumatic brain injury (TBI), and any associated increases in functional outcomes such as academic achievement in mathematics, behavior, social skills, and quality of life. A randomized controlled trial of the Cogmed (RM version) intervention for children with TBI. A total of 69 children post-TBI were screened for WM impairments, of which 31 eligible participants (Mage: 10.6 years; male n = 21) were recruited and randomized to either the treatment group (Cogmed, n = 16) or the active-control group (Lexia Reading Core5, n = 15). Both groups completed computerized training for 5 weeks with clinician support via an online video platform. Immediately posttraining and at 6 months follow-up, primary (WM and DM) and secondary functional outcomes were assessed. Immediately postintervention, significant improvement was found in one primary outcome (WM verbal component) for the Cogmed group, but this was not maintained at the 6 months follow-up. No immediate improvements or maintenance gains (small effect sizes) in other primary outcomes of visuospatial WM or DM were reported in the Cogmed group. No other significant group differences were detected for other functional outcomes. Despite the limited benefits observed in this small randomized controlled trial, it will be beneficial to investigate Cogmed's efficacy in a case-series methodology, to further determine its effectiveness in a pediatric TBI population. Furthermore, a cautious approach in clinical implementation of Cogmed is advised. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

The Importance of Identifying Children With Brain Injury in Schools: Speech-Language Pathologists as Crucial Partners

Purpose: The purpose of this article is to describe the importance of and strategies to identify traumatic brain injury (TBI) and associated cognitive-communication disorders (CCDs) in children, a priority identified by the attendees at the Fourth International Cognitive-Communication Disorders Conference. Childhood TBI is associated with a range of difficulties, including CCDs, that can adversely impact functioning and participation into adulthood. Identifying a history of TBI in children in schools is the crucial first step to then monitor, assess, and provide evidence-based intervention and accommodations in collaboration with families and medical and educational professionals. Conclusion: Given that CCDs are treatable, effective identification, assessment, and management of students with TBI and resulting CCDs can reduce adverse outcomes in adult survivors of childhood TBI. Speech-language pathologists must be aware of their expertise in assessing and treating CCDs in children with TBI and advocate for programmatic and policy changes to better identify and support children with TBI.

Impact of childhood traumatic brain injury on fitness for service class, length of service period, and cognitive performance during military service in Finland from 1998 to 2018: A retrospective register-based nationwide cohort study.

Traumatic brain injury (TBI) can cause neuronal damage and cerebrovascular dysfunction, leading to acute brain dysfunction and considerable physical and mental impairment long after initial injury. Our goal was to assess the impact of pediatric TBI (pTBI) on military service, completed by 65-70% of men in Finland. We conducted a retrospective register-based nationwide cohort study. All patients aged 0 to 17 years at the time of TBI, between 1998 and 2018, were included. Operatively and conservatively treated patients with pTBI were analyzed separately. The reference group was comprised of individuals with upper and lower extremity fractures. Information on length of service time, service completion, fitness for service class, and cognitive performance in a basic cognitive test (b-test) was gathered from the Finnish Military Records for both groups. Linear and logistic regression with 95% CI were used in comparisons. Our study group comprised 12 281 patients with pTBI and 20 338 reference group patients who participated in conscription. A total of 8 507 (66.5%) men in the pTBI group and 14 953 (71.2%) men in the reference group completed military service during the follow-up period. Men in the reference group were more likely to complete military service (OR 1.26, CI 1.18-1.34). A total of 31 (23.3%) men with operatively treated pTBI completed the military service. Men with conservatively treated pTBI had a much higher service rate (OR 7.20, CI 4.73-11.1). In the pTBI group, men (OR 1.26, CI 1.18-1.34) and women (OR 2.05, CI 1.27-3.36) were more likely to interrupt military service than the reference group. The PTBI group scored 0.15 points (CI 0.10-0.20) less than the reference group in cognitive b-test. PTBI groups had slightly shorter military service periods and higher interruption rate than our reference-group. There were only minor differences between groups in cognitive b-test.

Exploring Health-Related Social Needs and Components of Social Competence Following Childhood Traumatic Brain Injury.

Health-related social needs (HRSNs) impact general health care and educational outcomes for children with traumatic brain injury (TBI) and their families. Furthermore, children with TBI of all severities experience negative social competence outcomes chronically postinjury. However, studies have not investigated the relationship between HRSNs and social competence outcomes for children after TBI. The aim of this study was to identify the relationship between HRSNs and components of social competence (i.e., social skills, social communication, family functioning, and behavioral domains per the biopsychosocial framework for social competence) for children with TBI, per parent report. This study used a prospective, cross-sectional study design with a convenience sample. Online surveys were completed by parents of children with TBI (N = 22). On average, children with TBI were 4.84 years old at the time of their TBI and 9.24 years old at the time of study participation. Having a parent identify an HRSN in the domain of mental health was associated with social communication and family functioning difficulties for children with TBI. Statistically significant relationships were found between social communication and family functioning, externalizing behavior, and total behavior; family functioning and social relations; and family functioning and externalizing behavior. The findings of this study support that children with TBI experience chronic deficits in components of social competence, and HRSNs are associated with these outcomes. Further research needs to consider HRSNs to improve equitable prevention, supports, and services for children with TBI.

Behavior problems 7 years after severe childhood traumatic brain injury: Results of the Traumatisme Grave de L'Enfant study.

To investigate the occurrence of behavioral problems 7 years after severe pediatric traumatic brain injury (TBI), and their evolution from 3 months to 7 years postinjury. Thirty-four participants, 38% girls, M (SD) age at injury 7.6 (4.7) years, age at assessment 15 (4.6) years, underwent comprehensive assessments 7 years after severe TBI from March 2014 to March 2016 and were matched to a control group by age, gender, and parental education. A subgroup of 20 participants had available behavioral assessments at 3, 12, and 24 months postinjury. Internalizing, externalizing, and total behavioral problems were assessed with self- and parent reports of the Achenbach's Behavioral Checklist. Additional data included sociodemographic background, initial injury severity, and specific outcomes assessed concurrently 7 years postinjury. Compared to controls: (a) a significant proportion of participants with severe TBI fell above the clinical cutoff for self- (42%) and parent-reported (36%) externalizing problems, but not for self- (33%) or parent-reported (45%) internalizing problems; (b) withdrawn/depressed, intrusive behavior, and somatic complaints were significantly higher in self-reports; and (c) rule-breaking behavior, attention, and social problems were significantly higher in parent reports. Parent-reported internalizing problems were associated with older age at injury, whereas externalizing problems correlated with greater injury severity and concurrent levels of greater overall disability, lower intellectual ability, and poorer family functioning. In multiple hierarchical regression analyses, overall disability and worse family functioning significantly predicted externalizing problems. Parent-reported internalizing and externalizing problems persisted over time. These results highlight the importance of long-term follow-up and individualized behavioral interventions for children who sustained severe TBI. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Do preinjury life events moderate the outcomes of mild traumatic brain injuries in children? An A-CAP Study.

To examine preinjury life events as moderators of postconcussive symptoms (PCS) and quality of life (QoL) in children with pediatric mild traumatic brain injury (mTBI) versus orthopedic injury (OI). Participants were 633 children with mTBI and 334 with OI, ages 8-16.99, recruited from 5 pediatric emergency departments and followed for 6 months postinjury as part of a prospective cohort study. Preinjury life events were measured retrospectively using the Child and Adolescent Survey of Experiences, PCS using the Health and Behavior Inventory (HBI) and Post-Concussion Symptom Interview (PCS-I), and QoL using the Pediatric Quality of Life Inventory (PedsQL). Analyses involved longitudinal regression using restricted cubic splines, with group, positive and negative life events, and time as primary predictors. Covariates included age, sex, race, socioeconomic status, preinjury history (i.e., headache, migraine, previous concussion), and parent-rated retrospective PCS-I, HBI, and PedsQL scores. PCS and QoL were worse after mTBI than OI, but group differences declined with time (all p < .001). Group differences in PCS were larger at higher levels of positive life events, which predicted lower PCS (p= .03 to p < .001) and higher QoL (p = .048) after OI but not after mTBI. Negative life events predicted worse PCS and QoL in both groups (p = .002 to p < .001). Preinjury positive life events moderate outcomes after pediatric injury, with a protective effect seen in OI but not in mTBI. Negative life events are consistently associated with worse outcomes regardless of injury type.

Long-term burden of informal caregiver 7-years after severe childhood traumatic brain injury in the traumatisme grave de l’Enfant (TGE) study

ABSTRACT Objective To investigate reported burden by the Primary Family Caregiver (PFC) 7-years after severe pediatric traumatic brain injury in the TGE (Traumatisme Grave de l’Enfant) longitudinal study. Methods Subjective burden was estimated with the Zarit Burden Inventory (ZBI) in 36 PFC (parents), who rated their own health status (Medical Outcome Study Short Form-12), family functioning and their child’s level of care and needs (Pediatric/Adult Care And Needs Scale [PCANS/CANS]). Data collection included: child and PFC sociodemographic characteristics, injury-related factors, ‘objective’ (e.g. overall level of disability: Glasgow Outcome Scale – Extended, GOS-E/GOS-E-Peds) and ‘subjective’ outcomes (e.g. participation, behavior, executive functions, quality of life and fatigue). Results 25% of PFC reported mild-moderate burden, and 19% moderate-severe burden. Higher burden correlated with worse outcomes in all ‘subjective’ PFC-rated outcomes, and with self-reported participation. The ZBI correlated strongly with CANS/PCANS and GOS-E/GOS-E-Peds. Overall level of disability and PFC-reported executive functioning explained 62% of the ZBI variance. For equal levels of disability, burden was higher when PFC reported a ‘negative’ picture of their child. Conclusion Significant PFC-reported burden 7-years post-injury was associated with overall disability and ‘subjective’ PFC-rated outcomes. Factors influencing parental burden in the long term should be identified and psychological support implemented over time.

How significant is the BIG score in childhood traumatic brain injury?

This study aims to evaluate the reliability of the BIG score in predicting mortality in children with traumatic brain injury (TBI) and to compare it with the literature and other scoring systems. Patients who were followed up in the Pediatric Intensive Care Unit (PICU) for TBI between 2014 and 2019 in a tertiary reference hospital were evaluated retrospectively. One hundred fifty-nine patients met the inclusion criteria. The most common injury mechanisms were falling from a height (39.6%). The mortality rate was 12.6% (n = 20). The mean BIG score, ISS, and PRISM III were statistically significantly higher in the mortality group (p < 0.001). The AUC values found in the ROC analysis in the whole study group, respectively, 0.962 (CI 0.920-0.986) for the BIG score, 0.952 (CI 0.906-0.979) for the ISS, 0.957 (CI 0.913-0.983) for the GCS, and 0.981 (CI 0.946-0.996) for the PRISM III. In the patients with isolated TBI, the AUC value for the BIG score was 0.988 (0.967-1.000) and higher than the ISS and PRISM 3 [0.983 (0.956-1.000), 0.969 (0.932-1.000) respectively]). The cut-off point for the BIG score in the whole group was 19 (sensitivity 95%, specificity 88%, positive predictive value 0.58, negative predictive value 0.99). In logistic regression model, we found that BIG score is an independent variable for mortality (AOR:1.4, 95%CI 1.22-1.63). In children with traumatic brain injury, the BIG score is simple, quickly calculated, and a good predictor of mortality and disease severity. Prospective studies with more extensive series are needed on this subject.

Multidisciplinary approach to the treatment of traumatic brain injury in children and rehabilitation

Оbjective ‒ to show the need for a comprehensive approach to the treatment and rehabilitation of patients with traumatic brain injury (TBI); the specifics of psychosomatic and psychophysiological complications in children as a result of trauma. Materials and methods. In period from 2019 to 2024 in the National Children's Specialized Hospital Okhmatdyt was applied a multidisciplinary approach in the treatment of TBI in 112 patients (children from 9 months to 16 years, the main group). In 22 (19.7 %) cases had isolated TBI and in 90 (80.3 %) had polytrauma. The peculiarity of treating children in the period 2022‒2024 is the presence of injuries as a result of hostilities. The mental state was assessed at the time of discharge and 3 months later using the State-Trait Anxiety Inventory (STAI) and the Kerdo index, and the Ronde index was used also. The control group was formed from 115 children who were treated until 2019, comparable in terms of age, type of injuries, length of stay in the hospital with patients of the main group.Results. The main complications in the psychoemotional, cognitive, psychosomatic, psychophysiological spheres are presented. The main general approaches in the treatment of brain injury and its consequences regarding the basic communicative work of a multidisciplinary team are shown: anesthesiologist, neurosurgeon, trauma surgeon, general surgeon, psychologist, neurologist, radiologist, doctor of functional diagnostics, rehabilitator. The features of anesthesiologist's work during sedation and anesthesia are described. A comparative assessment of the patient’s condition at discharge under 2019 (without of the principle of a multidisciplinary approach using) and in children who were treated with this method was performed. The dynamics of the various complications types presence in patients before 2019 and after was showed (with or without the multidisciplinary approach in treatment). Conclusions. A multidisciplinary approach to the treatment of both isolated TBI and polytrauma ensures timely diagnosis of psychological, psychosomatic, and psychophysiological disorders, and allows the involvement of appropriate specialists who carry out correction and rehabilitation. All this improves the quality of treatment and reduces the frequency of complications. Specialists who provide assistance to children with trauma should know the age-based foundations of child psychology in order to timely involve a psychologist in diagnosis and treatment at the stages of traumatic injury. Communication in the work between specialists makes it possible to pay attention to the peculiarities of the traumatic process, the complications that arise and to carry out correction and necessary rehabilitation in a timely manner. The most pronounced psychological and psychophysical complications in the main group were among children who suffered as a result of military actions and cruel treatment. Three months after receiving the injury, asthenic syndrome remained in 29.5 % of patients of the main group, 24.5 % of patients of the control group. In the control group, there is a decrease in these symptoms, but to a lesser extent, it can be interpreted so that the psychologist's recommendations were not taken into account by the neurosurgeon (surgeon) and the psychologist was not always involved in the treatment process, or some recommendations were not followed by the parents at the outpatient stage after discharge.

Cortisol Dynamics, Quality of Life, and Fatigue following Traumatic Brain Injury in Childhood

Introduction: Traumatic brain injury (TBI) is a leading cause of acquired neurological morbidity. The prevalence of post-traumatic hypopituitarism and associated morbidity after childhood TBI is unclear. Our study investigated long-term hypothalamus-pituitary-adrenal (HPA) axis function, in a prospective childhood TBI and control cohort, using measures of cortisol/cortisone secretion (physiological and stimulated), HPA axis feedback, and exploring associations with fatigue, depression, and quality of life (QoL) outcomes. Methods: All TBI participants had data concerning severity and mechanism of TBI. All groups had clinical assessment, pituitary/brain MRI, questionnaire measures of QoL, fatigue, depression, and salivary cortisone profiles including dexamethasone suppression test. In addition, participants with moderate/severe TBI had ethical approval for baseline endocrine blood tests, overnight 12-h venous sampling of cortisol and growth hormone, and stimulated HPA axis evaluation with an insulin tolerance test (ITT). Results: Seventy-two participants with moderate/severe (n = 31, age 19.8 ± 4.2 years) or mild TBI (n = 24, age 17.8 ± 5.1 years) and matched controls (n = 17, age 18.5 ± 5.5 years) took part. Time post-TBI was 6.8–10.8 years. Baseline endocrine tests confirmed normal thyroid and posterior pituitary function. One female with moderate/severe TBI had hypogonadism. Pituitary neuroimaging was normal in all participants. In 2/25 ITT and 9/22 overnight serum profiles, peak cortisol was Conclusion: Although not as prevalent as previously reported, HPA axis dysfunction does occur in survivors of childhood TBI, confirming the need for endocrine surveillance. However, in most of our paediatric TBI survivors assessed 7–11 years post-TBI, HPA function and circadian rhythmicity were preserved or had recovered. Chronic fatigue is a common concern post-TBI, but in the majority, it is not associated with frank HPA axis dysfunction. Morning salivary cortisone levels were higher in TBI survivors (who have a high prevalence of fatigue) compared to healthy controls, despite the recognised association of chronic fatigue with cortisol hyposecretion.

Autologous bone marrow mononuclear cells to treat severe traumatic brain injury in children.

Autologous bone marrow mononuclear cells (BMMNCs) infused after severe traumatic brain injury have shown promise for treating the injury. We evaluated their impact in children, particularly their hypothesized ability to preserve the blood-brain barrier and diminish neuroinflammation, leading to structural CNS preservation with improved outcomes. We performed a randomized, double-blind, placebo-sham-controlled Bayesian dose-escalation clinical trial at two children's hospitals in Houston, TX and Phoenix, AZ, USA (NCT01851083). Patients 5-17 years of age with severe traumatic brain injury (Glasgow Coma Scale score ≤ 8) were randomized to BMMNC or placebo (3:2). Bone marrow harvest, cell isolation and infusion were completed by 48 h post-injury. A Bayesian continuous reassessment method was used with cohorts of size 3 in the BMMNC group to choose the safest between two doses. Primary end points were quantitative brain volumes using MRI and microstructural integrity of the corpus callosum (diffusivity and oedema measurements) at 6 months and 12 months. Long-term functional outcomes and ventilator days, intracranial pressure monitoring days, intensive care unit days and therapeutic intensity measures were compared between groups. Forty-seven patients were randomized, with 37 completing 1-year follow-up (23 BMMNC, 14 placebo). BMMNC treatment was associated with an almost 3-day (23%) reduction in ventilator days, 1-day (16%) reduction in intracranial pressure monitoring days and 3-day (14%) reduction in intensive care unit (ICU) days. White matter volume at 1 year in the BMMNC group was significantly preserved compared to placebo [decrease of 19 891 versus 40 491, respectively; mean difference of -20 600, 95% confidence interval (CI): -35 868 to -5332; P = 0.01], and the number of corpus callosum streamlines was reduced more in placebo than BMMNC, supporting evidence of preserved corpus callosum connectivity in the treated groups (-431 streamlines placebo versus -37 streamlines BMMNC; mean difference of -394, 95% CI: -803 to 15; P = 0.055), but this did not reach statistical significance due to high variability. We conclude that autologous BMMNC infusion in children within 48 h after severe traumatic brain injury is safe and feasible. Our data show that BMMNC infusion led to: (i) shorter intensive care duration and decreased ICU intensity; (ii) white matter structural preservation; and (iii) enhanced corpus callosum connectivity and improved microstructural metrics.

The use of transcranial micropolarization in the acute period of severe traumatic brain injury in children

To assess the effectiveness of using transcranial micropolarization in acute period of severe traumatic brain injury in children. The study on the effectiveness of using transcranial micropolarization in acute period of severe traumatic brain injury in 85 children, divided into 2 groups, was carried out. The study group (42 patients) received the transcranial micropolarization on the 2nd day after severe traumatic brain injury. The control group (43 patients) received only rehabilitation in neurosurgery department. The neurological status in the patients of both groups was assessed on the 2nd day after severe traumatic brain injury in resuscitation department, and after 1, 3 and 6 months. The inclusion of transcranial micropolarization in the early medical rehabilitation of children with severe traumatic brain injury increases consciousness level in a shorter period of time, that predicts early patient's socialization.

Диагностика нутритивных нарушений у детей после перенесенной черепно-мозговой травмы (обзор современных рекомендаций)

Traumatic brain injury (TBI) is one of the main causes of disability and mortality in the population, and in young people it ranks first. Children after TBI, in addition to neurological problems, have a number of somatic ones, such as malnutrition, dysphagia, and motor disorders of the gastrointestinal tract. Hypercatabolism causes the formation of malnutrition and loss of a significant part of muscle mass in these patients. Gastrointestinal problems limit adequate nutrition. In combination with neurological disorders – motor disorders, long-term immobilization, epilepsy – this can lead to the development of sarcopenia. The presence of sarcopenia, in turn, reduces the rehabilitation potential and directly affects the restoration and acquisition of motor functions. Therefore, it is important to assess and correct nutritional status in children with TBI not only in the acute period, but also during the early restorative treatment. The purpose — to analyze the available literature on the features of assessing nutritional status in children after traumatic brain injury. Results. Children after TBI are prone to immobilization, which leads to loss of muscle mass and bone mineral density, as well as an increase in fat mass. According to the guidelines of the European Society of Pediatric Gastroenterologists, Hepatologists and Nutritionists (ESPGHAN), it is recommended to assess the nutritional status of children with neurological diseases using anthropometry, body composition, and some laboratory parameters. To date, a universal marker of nutritional status disorders in children with neurological diseases in general and with TBI in particular has not been identified. The clinical recommendations «Traumatic brain injury in children» (2022) indicate that such routine laboratory markers of nutrition assessment as total protein, serum albumin, prealbumin, retinol-binding protein, as well as anthropometry have not proven their effectiveness in assessing the state of muscle mass. The «gold standard» in determining the body composition is the bioimpedansometry method, which allows assessing the content of active cell mass, muscle mass, fat and fat-free mass, the total water content. To achieve optimal anthropometric parameters, body composition and rehabilitation prognosis, it is recommended to use indirect calorimetry instead of equations to calculate the resting energy expenditure. Conclusion. The current Federal Clinical Guidelines for the Treatment of Children with TBI (2022) do not have an algorithm and a clear approach to assessing nutritional status and prescribing nutritional support for children of this vulnerable group. To assess the nutritional status, regardless of the level of the hospital, it is recommended to use anthropometry with dynamic control. To assess the body composition it is recommended to use bioimpedansometry, if it is unavailable — mid-upper arm circumference using MUAC tapes, as well as caliperometry. It is also recommended to assess the level of trace elements, with dynamic control at 6 months or annually.

The predicative value of early quantitative electroencephalograph in epilepsy after severe traumatic brain injury in children.

To explore whether early quantitative electroencephalograph (EEG) can predict the development of epilepsy in pediatric patients with severe traumatic brain injury (TBI). A total of 78 children with severe TBI who were admitted to our hospital were divided into post-traumatic epilepsy (PTE) and non-PTE groups according to whether or not they developed PTE. EEGs of frontal, central and parietal lobes were recorded at the time of their admission. The power values of each frequency band, odds ratio and peak envelope power values of each brain region were statistically analyzed. In addition, the patients were followed up for two years, and the occurrence of PTE was documented. During the follow-up period, PTE occurred in 8 patients. Analysis of EEG signals across different brain regions (frontal, central, and parietal lobes) revealed significant differences between the PTE and non-PTE groups. Patients with PTE exhibited significantly higher δ and θ power values (P < 0.01), lower α/θ ratios (P < 0.01), and elevated θ/β, (δ + θ)/(α + β), and peak envelope power (P < 0.01) compared to those in the non-PTE group. In children with severe TBI, the parameter characterization of early quantitative EEG has potential application in predicting PTE.