Increased adenosine concentration in cerebrospinal fluid after severe traumatic brain injury in infants and children: Association with severity of injury

Courtney Robertson, Michael J. Bell, Patrick M. Kochanek, P. David Adelson, Randall Ruppel, Stephen Wisniewski, Zaichuan Mi, Keri L. Janesko, Robert S B Clark, Edwin K. Jackson

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Abstract

Introduction: Traumatic brain injury (TBI) in children results in a myriad of pathophysiologic derangements that contribute to secondary injury, including hypoperfusion, energy failure and excitotoxicity. In addition, a number of endogenous neuroprotectants are produced after TBI, including adenosine, which increases cerebral blood flow and reduces metobolic demands1,2. In a prior evaluation of cerebrospinal fluid (CSF) of children following severe TBI3, we demonstrated increased peak levels of adenosine after TBI. In the current study, we evaluate the CSF of an expanded sample of infants and children following severe TBI, and examine the contribution of age, GCS, mechanism of injury and time after injury to CSF adenosine levels. Methods: Samples (n=304) of ventricular CSF were collected from 27 infants and children (2 mo to 14 y) during the first 7 d after severe TBI (GCS 4 and time after injury (both p 4y). Conclusions: We conclude CSF adenosine concentration is increased in infants and children after severe TBI. This increase was especially pronounced in children with the most severe injuries. Unlike mediators of secondary damage, such as glutamate 4, adenosine was not associated with child abuse or age ≤4 y. We speculate that adenosine may play an important role in endogenous attempts at neuroprotection after TBI.

Original languageEnglish (US)
JournalCritical Care Medicine
Volume27
Issue number12 SUPPL.
Publication statusPublished - 1999
Externally publishedYes

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ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine

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