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American Journal of Medical Case Reports. 2023, 11(2), 23-27
DOI: 10.12691/AJMCR-11-2-4
Case Report

Neonatal Brain Death and Current Controversies: An Illustrative Case

Lydia Leavitt1,

1University of Illinois College of Medicine, Rockford, IL, United States

Pub. Date: February 05, 2023

Cite this paper

Lydia Leavitt. Neonatal Brain Death and Current Controversies: An Illustrative Case. American Journal of Medical Case Reports. 2023; 11(2):23-27. doi: 10.12691/AJMCR-11-2-4

Abstract

Brain death is a difficult determination, often involving legal, ethical, and moral dilemmas for care teams and families. Determination of brain death in the neonate is particularly difficult due to ambiguous and inconsistent guidelines, which have generated controversies and debates regarding several components of the brain death examination in neonates. The treatment team of a term neonate who suffered a severe hypoxic-ischemic brain injury during birth encountered numerous uncertainties as they navigated the brain death determination guidelines. This was the first time a neonatal brain death determination was performed at this 52-bed level III neonatal intensive care unit.

Keywords

neonatology, brain death, hypoxic-ischemic encephalopathy

Copyright

Creative CommonsThis work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

References

[1]  Beck CS, Pritchard WH, Feil HS. Ventricular fibrillation of long duration abolished by electric shock. J Am Med Assoc 1947; 135: 985.
 
[2]  Belkin GS. Brain death and the historical understanding of bioethics. Journal of the History of Medicine and Allied Sciences 2003; 58: 325-61.
 
[3]  Fainberg N, Mataya L, Kirschen M, Morrison W. Pediatric brain death certification: a narrative review. Transl Pediatr. 2021 Oct; 10(10): 2738-2748.
 
[4]  A definition of irreversible coma. Report of the Ad Hoc Committee of the Harvard Medical School to Examine the Definition of Brain Death. JAMA 1968; 205: 337-40.
 
[5]  President’s Commission for the Study of Ethical Problems in Medicine and Biomedical and Behavioral Research. Defining Death: A Report on the Medical, Legal and Ethical Issues in the Determination of Death. Available online: http://www.thaddeuspope.com/s/President_Comm_on_Def_Death_1981.pdf.
 
[6]  Nakagawa TA, Ashwal S, Mathur M, et al. Clinical report—Guidelines for the determination of brain death in infants and children: an update of the 1987 task force recommendations. Pediatrics 2011; 128: e720-40.
 
[7]  Greer DM, Shemie SD, Lewis A, Torrance S, Varelas P, Goldenberg FD, Bernat JL, Souter M, Topcuoglu MA, Alexandrov AW, Baldisseri M, Bleck T, Citerio G, Dawson R, Hoppe A, Jacobe S, Manara A, Nakagawa TA, Pope TM, Silvester W, Thomson D, Al Rahma H, Badenes R, Baker AJ, Cerny V, Chang C, Chang TR, Gnedovskaya E, Han MK, Honeybul S, Jimenez E, Kuroda Y, Liu G, Mallick UK, Marquevich V, Mejia-Mantilla J, Piradov M, Quayyum S, Shrestha GS, Su YY, Timmons SD, Teitelbaum J, Videtta W, Zirpe K, Sung G. Determination of Brain Death/Death by Neurologic Criteria: The World Brain Death Project. JAMA. 2020 Sep 15; 324(11): 1078-1097.
 
[8]  Chatziioannidis I, Chouchou P, Nikolaidis N. Is brain death diagnosis in newborns feasible? Hippokratia. 2012 Oct; 16(4): 308-11.
 
[9]  Joffe AR, Anton NR, Duff JP. The apnea test: rationale, confounders, and criticism. J Child Neurol 2010; 25: 1435-43.
 
[10]  McIntosh, N., Abbot, J., Brierley, J., Kennedy, C., Marshment, V., McFadzean, J., Snowdon, C., Stoodley, N., Tasker, R., Wilkinson, D., Willis, L. and Wyatt, J., 2015. Diagnosis of death by neurological criteria (DNC) in infants less than two months old - clinical guideline. [online] RCPCH. Available at: <https://www.rcpch.ac.uk/resources/diagnosis-death-neurological-criteria-dnc-infants-less-two-months-old-clinical-guideline> [Accessed 12 March 2022].
 
[11]  Banasiak KJ, Lister G. Brain death in children. Curr Opin in Pediatrics. 2003; 15: 288-293.
 
[12]  Herman, ST, Abend, NS, Bleck, TP, et al. Consensus statement on continuous EEG in critically ill adults and children, part I: indications. J Clin Neurophysiol. 2015; 32(2): 87-95.
 
[13]  Joffe, A. R., deCaen, A., & Garros, D. (2020). Misinterpretations of Guidelines Leading to Incorrect Diagnosis of Brain Death: A Case Report and Discussion. Journal of Child Neurology, 35(1), 49-54.
 
[14]  Weise KL, Okun AL, Carter BS, Christian CW; COMMITTEE ON BIOETHICS; SECTION ON HOSPICE AND PALLIATIVE MEDICINE; COMMITTEE ON CHILD ABUSE AND NEGLECT. Guidance on Forgoing Life-Sustaining Medical Treatment. Pediatrics. 2017 Sep; 140(3): e20171905.
 
[15]  Mills M, Cortezzo DE. Moral Distress in the Neonatal Intensive Care Unit: What Is It, Why It Happens, and How We Can Address It. Front Pediatr. 2020 Sep 10; 8: 581.