Considerations for the pediatric coma patient: not just small adults

Coma is a relatively common condition in the pediatric intensive care unit. Although the principles of diagnosis and management are basically the same for both children and adults, there are some age-specific aspects related to infants and children under 16 years of age that influences the pediatric intensive care practitioner’s conduct. Several aspects regarding neuroplasticity, raised intracranial pressure and epileptogenesis in the immature brain are considered in this article. Importantly, the role of new technologies employed for neurophysiologic monitoring is also reviewed. The aim of this article is to evaluate the main issues comprising the comatose state in childhood and their differences from the same condition in adulthood. Several differences in the physiology of immature brains can affect clinical and neurophysiologic expression in a disorder of consciousness and may need special proceedings for its management. Future perspectives in the field are referred in the final part of this article.