Neonatal Brain Death

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Specializes in ICU.

We had a pregnant pt come in who was in a car accident, they did an emergency C-section, coded the baby for a while, and then declared her brain dead and brought her to the mommy to die. In the ICU, brain dead patients are completely dependent on a vent and pressors. This baby was still breathing, kind of gurgly, but still breathing an hour after they brought her. What is the criteria for brain death in the NICU? This was a heart-breaker. We do not like to get pregnant or post-partum mommies in the ICU. :scrying:

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Specializes in NICU, PICU, educator.

There are some missing links/info on this.....brain dead is brain dead, but with neonates there are many more issues at hand. It also depends on what the family wants. Was there massive trauma, were they unable to intubate or ventilate, how long did they code? Was the baby down for over 30 minutes when they resucitated and were they not able to get the HR up over 60 for an extended period of time despite meds/ventilation?

In all my years in NICU, I have only seen a handful of kids actually declared brain dead, 2 were drug kids that mom abrupted, 2 were MVA and one was from birth trauma.

That is so sad :( Hugs to you and your coworkers!

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Specializes in ICU.

I must have just misunderstood what was going on and I really don't know what steps were taken, except that she was coded. Maybe they decided it was futile or maybe the family made the baby a DNR. Do they do that? Seeing that sweet little baby who was on her way to heaven was such a tender experience. Maybe I could find a home in NICU. It can't be that different from adult ICU, right? ;)

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Just like with adults you can't declare a baby "brain dead" unless the EEG is flat. I'm guessing the code went very poorly and the parents said they could stop.

Those kinds of codes stink.

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Specializes in Neonatal ICU (Cardiothoracic).

What Dawngloves said.... you need an EEG without brain activity with normal gases and lytes to establish brain death....

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Specializes in Level III NICU.
I must have just misunderstood what was going on and I really don't know what steps were taken, except that she was coded. Maybe they decided it was futile or maybe the family made the baby a DNR. Do they do that?

Yes, we will offer the option of a DNR when the situation is futile. It sounds like that may have been the case in your situation. It is usually the kindest thing we could do for the baby, rather than torture him/her with repeated codes. I don't think I've actually ever seen a baby declared brain dead, but I have seen parents opt to make a baby a DNR after prolonged codes and abnormal EEGs and such.

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Specializes in NICU.

We had a baby pronounced brain dead. I believe it was pronounced as soon as the EEG came back flat.

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Specializes in Ob/Gyn - NICU.

We had a 3 month baby pronounced brain dead once . EEG came back flat, doctor wanted to wait and repeat EEG but little baby didn´t resist and died about 2 hours later.

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Specializes in NICU, PICU, PCVICU and peds oncology.
What Dawngloves said.... you need an EEG without brain activity with normal gases and lytes to establish brain death....

Actually, no you don't. (http://www.neurotransmitter.net/braindeath.html)Deep anaesthesia and post-cardiac arrest states can produce a flat EEG. And the US does NOT require EEG evidence of brain death, although it is considered confirmatory. Brain death detemination may include two isoelectric (flat) EEGs 24 hours apart in addition to the other criteria: absence of response to pain, absence of cranial nerve reflexes (oculocephalic, pupillary, corneal and vestibulo-ocular or cold caloric reflex), absence of spontaneous respirations. The gold standard is the radionuclide cerebal flow study.

What is brain death? It's the irreversible cessation of clinical function of all parts of the brain, including the brain stem. Massachussetts General Hospital has an excellent resource for brain death detemination that you can find here: http://www.massgeneral.org/stopstroke/protocolBrainDeath.aspx

Now after all that, I'm sure a little digging would reveal that the establishment of brain death in neonates is very rarely done due to confounding factors such as the immature respiratory chain in neonates that will produce apnea in an infant with a normal but "half-baked" brain. And most experts recommend a waiting period of 7 days after the precipitating event before testing is initiated.

http://www.emedicine.com/neuro/topic491.htm

http://www.aic.cuhk.edu.hk/web8/brain_death_and_care_of_organ_do.htm

BlueEyedRN, you and your coworkers have my sympathy. This situation is a tragedy for all involved.

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