The determination of brain death in infants and children: A review of the updated brain death guidelines for infants and children

The 1987 consensus-based guidelines for the determination of brain death in children have served to provide clinicians with direction to declare brain death in children. These guidelines for determination of brain death in children have not been reviewed or revised during this time period. The 1987 guidelines to determine brain death in children suffer from limitations including: limited clinical information at the time of publication, ancillary studies that relied heavily upon electroencephalographic testing, and age-based criteria with little direction to address brain death in neonates. These limitations have resulted in confusion and a lack of standardization among physicians who are tasked with determining brain death in children. An update of the pediatric brain death guidelines was needed to clarify important issues such as observation intervals, guidelines to determine brain death for the term newborn, use of ancillary studies for all age groups, and providing clinicians with a more uniform approach to determining brain death in infants and children. The Pediatric Section of the Society of Critical Care Medicine and the Section on Critical Care of the American Academy of Pediatrics, in conjunction with the Child Neurology Society, formed a multidisciplinary committee of medical and surgical subspecialists with the support of the American College of Critical Care Medicine to review and revise the 1987 guidelines. The updated clinical guidelines are designed to promote standardization of brain death determination for medical specialists who are tasked with determining death in infants and children. The following is a review of the updated guidelines to determine brain death in infants and children.