Traumatic brain injury in infants and toddlers, 0–3 years old

OBJECT Children 0-3 years old present a completely different neurotraumatic pathology. The growing and the development processes in this age group imply specific anatomical and pathophysiological features of the skull, subarachnoid space, CSF flow, and brain. Most common specific neurotraumatic entities in children 0-3 years old are cephalhematoma, subaponeurotic (subgaleal) hematoma, diastatic skull fracture, grow skull fracture, depressed ('ping-pong') skull fracture, and extradural hematoma. METHODS We present our 10 years experience in neuropediatric traumatic brain injuries, between 1999 and 2009, in the First Department of Neurosurgery and Pediatric Intensive Care Unit. Including criteria were children, 0-3 years old, presenting only traumatic brain injury. We excluded patients with politrauma, who require a different management. RESULTS We present the incidence of these specific head injuries, clinical and imagistic features, treatment, and outcome. We found 72 children with diastatic skull fracture, 61 cases with depressed ('ping-pong') skull fracture, 22 cases with grow skull fracture, 11 children harboring intrusive skull fracture, 58 cephalhematomas, 26 extradural hematomas, and 7 children with severe brain injury and major posttraumatic diffuse ischemia ('black-brain'). Usually, infants and toddlers present with seizures, pallor, and rapid loss of consciousness. First choice examination, in all children was cerebral CT-scan, and for follow-up, we performed cerebral MRI. We emphasize on the importance of seizure prevention in this age group. Children presenting with extensive diffuse ischemia ('black-brain') had a poor outcome, death occurring in all 7 cases. CONCLUSION Children 0-3 years old, present with a total distinctive pathology than adults. Children with head injury must be addressed to a pediatric department of neurosurgery and pediatric intensive care unit. Prophylaxis pays the most important role in improving the outcome.