This review of the highly complex area of pediatric NIC allows several conclusions:
| 1. |
The relative importance of primary injury has probably been underestimated. Secondary, hypoxemicischemic injury was, incorrectly, thought to be easily managed with improvement in prognosis. For this reason equal or even more efforts should be put into prophylaxis rather than into highly sophisticated corrective measures after the insult.
|
| 2. |
Every method of monitoring the child in coma has its strong and weak points and may therefore give misleading data. For this reason a combination of inter-independent monitoring techniques has to be applied.
|
| 3. |
The main aim of NIC is to enable an injured child and his family to resume a normal and happy life. If, early after the critical event, there are signs of poor outcome, particularly of persistent vegetative state or severe disability, consideration should be given to early withdrawal of support, always in accordance to the local socio-ethical customs. The decision to stop vital support can be taken only after extremely careful and repeat, but speedy analysis of the case, using inter-independent and reliable methods of evaluation.
|
| 4. |
The history of NIC underlines again the need of carefully conducted, controlled and prospective clinical studies. Only in this way can swings of over-enthusiasm and disillusionment be avoided. This seems to be particularly important as there is a whole series of new concepts on the horizon ranging from calcium blocking agents to free radical scavengers (including 21-aminosteroids) and antagonists of excitatory neurotransmitters and excitotoxins [135].
|