{
    "abstract": "We aimed to assess medium-to long-term neurological outcomes in children with severe acute brain injury (ABI) and to identify cardiovascular predictors associated with unfavorable outcomes, such as heart rate (HR), blood pressure (BP), and heart rate variability (HRV). HRV refers to the oscillations in the intervals between consecutive heartbeats, reflecting the dynamic interplay between sympathetic and parasympathetic impulses to the heart. It provides a non-invasive indicator of autonomic nervous system (ANS) activity.\nProspective observational cohort.\nTertiary academic pediatric intensive care unit (PICU).\nChildren >27 days and <18 years old admitted to the PICU after severe ABI who survived to PICU discharge. Children suspected of being brain dead at PICU admission or with cardiac arrythmias were excluded.\nNone.\nments: Physiological variables, neurological data, chemistry and hematologic tests and medication were collected within the initial 12\u00a0h following admission to the PICU. Linear and nonlinear indices of HRV obtained from electrocardiogram (ECG) Holter recordings, computerized tomography (CT) and PICU scores, as well as survival rates within the PICU, were evaluated. The primary outcome measure was global functional outcome as measured by the Pediatrics Glasgow Outcome Scale Extended (GOSE-Peds) at 3 and 12 months after injury. These data were taken by reviewing the medical records. The outcome was dichotomized into favorable and unfavorable based on predefined cutoffs. None to mild disability (GOSE-E PEDS category \u22642) was categorized as favorable outcome, whereas moderate to severe disability was categorized as unfavorable (GOSE-E PEDS category \u22653).\nThirty-one children with ABI were eligible for the study. Twenty-four were male (77.4\u00a0%) and they had the median age of 11.3 years old (IQR 5.6-14.3). Twenty-two (71.0\u00a0%) patients had traumatic brain injury (TBI) and five (16.1\u00a0%) cerebral hemorrhage. Sixteen children (51.6\u00a0%) had a favorable outcome at 3 months and twenty-one (67.7\u00a0%) at 12 months. The presence of tachycardia or bradycardia was not related to the prognosis. Patients with systolic arterial blood pressure (SBP) above the 95th percentile in the first 12\u00a0h after admission to the PICU exhibited a significantly better neurological outcome [15 (68.2\u00a0%) vs. 9 (31.8\u00a0%), p\u00a0=\u00a00.006] at 3 months, and [20 (83.3\u00a0%) vs. 4 (16.7\u00a0%), p\u00a0=\u00a00.002] at 12 months. Calculated HRV values were higher, both on admission and 12\u00a0h after admission, in patients with a favorable prognosis at 3 and 12 months. However, these results were statistically significant only for RMSSD, LF, TP, and Poincar\u00e9 SD1 and SD2 at 12\u00a0h after admission and for outcomes at 3 months. Patients with LF\u00a0>\u00a070.0\u00a0ms\nThis study suggests that elevated early SBP and HRV indices-particularly LF power measured 12\u00a0h after PICU admission-may serve as independent, non-invasive predictors of long-term neurological outcomes in children with severe ABI. These findings support the role of early autonomic activation as a marker of favorable prognosis and underscore the potential value of incorporating cardiovascular and autonomic monitoring into prognostic models and individualized neuroprotective strategies in pediatric neurocritical care.",
    "authors": [
        {
            "affiliation": "Pediatric Intensive Care Unit, S\u00e3o Jo\u00e3o University Hospital Center, Porto, Portugal; Ginecology-Obstetrics and Pediatrics Department, Faculty of Medicine, University of Porto, Portugal; CINTESIS@RISE, Faculty of Medicine, University of Porto, Portugal; Centro de Matem\u00e1tica, Universidade do Porto, Porto, Portugal. Electronic address: mjsilva@med.up.pt.",
            "firstname": "Marta Jo\u00e3o",
            "initials": "MJ",
            "lastname": "Silva"
        },
        {
            "affiliation": "Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Portugal; CINTESIS@RISE, Faculty of Medicine, University of Porto, Portugal.",
            "firstname": "Hern\u00e2ni",
            "initials": "H",
            "lastname": "Gon\u00e7alves"
        },
        {
            "affiliation": "Department of Community Medicine, Information and Health Decision Sciences (MEDCIDS), Faculty of Medicine, University of Porto, Portugal; CINTESIS@RISE, Faculty of Medicine, University of Porto, Portugal; Centro de Matem\u00e1tica, Universidade do Porto, Porto, Portugal.",
            "firstname": "Rute",
            "initials": "R",
            "lastname": "Almeida"
        },
        {
            "affiliation": "CINTESIS@RISE, Faculty of Medicine, University of Porto, Portugal; Knowledge Management Unit, Faculty of Medicine, University of Porto, Portugal.",
            "firstname": "Cla\u00fadia Camila",
            "initials": "CC",
            "lastname": "Dias"
        },
        {
            "affiliation": "Neuroradiology Department, S\u00e3o Jo\u00e3o University Hospital Center, Porto, Portugal.",
            "firstname": "Ana Isabel",
            "initials": "AI",
            "lastname": "Almeida"
        },
        {
            "affiliation": "Centro de Matem\u00e1tica, Universidade do Porto, Porto, Portugal; Departmento de Matem\u00e1tica, Faculdade de Ci\u00eancias, Universidade do Porto, Portugal.",
            "firstname": "Ana Paula",
            "initials": "AP",
            "lastname": "Rocha"
        },
        {
            "affiliation": "CINTESIS@RISE, Faculty of Medicine, University of Porto, Portugal; Anaesthesiology Department, S\u00e3o Jo\u00e3o University Hospital Center, Porto, Portugal; Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Portugal.",
            "firstname": "Cristina",
            "initials": "C",
            "lastname": "Granja"
        },
        {
            "affiliation": "Ginecology-Obstetrics and Pediatrics Department, Faculty of Medicine, University of Porto, Portugal; Pediatric Cardiology Department, S\u00e3o Jo\u00e3o University Hospital Center, Porto, Portugal.",
            "firstname": "Maria Jo\u00e3o",
            "initials": "MJ",
            "lastname": "Baptista"
        },
        {
            "affiliation": "Ginecology-Obstetrics and Pediatrics Department, Faculty of Medicine, University of Porto, Portugal; CINTESIS@RISE, Faculty of Medicine, University of Porto, Portugal; Pediatric Department, S\u00e3o Jo\u00e3o University Hospital Center, Porto, Portugal.",
            "firstname": "In\u00eas",
            "initials": "I",
            "lastname": "Azevedo"
        }
    ],
    "conclusions": null,
    "copyrights": "Copyright \u00a9 2025 The Authors. Published by Elsevier Ltd.. All rights reserved.",
    "doi": "10.1016/j.ejpn.2025.04.009",
    "journal": "European journal of paediatric neurology : EJPN : official journal of the European Paediatric Neurology Society",
    "keywords": [
        "Blood pressure",
        "Brain injury",
        "Children",
        "Disability",
        "Heart rate",
        "Heart rate variability",
        "Morbidity",
        "Outcome",
        "Prognosis"
    ],
    "methods": null,
    "publication_date": "2025-04-27",
    "pubmed_id": "40286565",
    "results": null,
    "title": "The role of cardiovascular response as a predictor of neurologic disability in children with brain injury - a pilot study.",
    "xml": "<Element 'PubmedArticle' at 0x788503579b70>"
}