Brain death in the newborn.

The clinical courses of 18 preterm and term infants less than 1 month of age in whom brain death was diagnosed were retrospectively reviewed. Clinical diagnosis was determined neurologically and included (1) coma, (2) apnea, manifested by inability to sustain respiration, and (3) absent brainstem reflexes. Electroencephalograms were performed in all patients; 17 patients had adequate cerebral blood flow as estimated by radionuclide imaging. The results indicate that (1) neurodiagnostic tests such as electroencephalograms and radionuclide scanning reconfirmed clinically determined brain death in only one half to two thirds of patients; (2) electrocerebral silence in the absence of barbiturates, hypothermia, or cerebral malformations during 24 hours was confirmatory of brain death if the clinical findings remained unchanged; (3) absence of radionuclide uptake associated with initial electrocerebral silence was associated with brain death; (4) term infants clinically brain dead for 2 days and preterm infants brain dead for 3 days did not survive despite electroencephalogram or cerebral blood flow status; and (5) phenobarbital levels greater than 25 micrograms/mL may suppress electroencephalographic activity in this age group. The findings suggest that determination of brain death in the newborn can be made solely by using clinical criteria. Confirmatory neurodiagnostic studies are of value because they can potentially shorten the period of observation.