Death by Neurologic Criteria in three Pediatric Intensive Care Units in Chile: Current status and future perspectives.

Background: Death in pediatrics is one of the most challenging situations encountered by both families and healthcare professionals. Despite its clinical, ethical, and legal relevance, death by neurologic criteria (DNC), also known as brain death (BD), remains poorly characterized in pediatric intensive care units (PICUs). Brain death is defined as the irreversible loss of function of the cerebral hemispheres and brainstem and is legally equivalent to death determined by cardiopulmonary criteria. Although DNC has a low prevalence in pediatric critical care, it carries significant implications for end-of-life care, family counseling, and organ donation. To date, epidemiological data regarding pediatric DNC in Chile have been unavailable. Objective: To determine the frequency of death by neurologic criteria, describe the clinical and epidemiological characteristics of affected patients, and evaluate organ donation rates in three tertiary pediatric intensive care units in Santiago, Chile. Methods: A retrospective, observational, descriptive study was conducted in the PICUs of Luis Calvo Mackenna Hospital, Exequiel Gonzalez Cortes Hospital, and Roberto del Rio Hospital between January 1, 2014, and January 1, 2024. Medical records of deceased patients were reviewed to identify cases of areflexic coma and brain death. Demographic characteristics, admission diagnoses, mechanisms of irreversible neurological injury, diagnostic procedures, neuroimaging findings, ancillary testing, clinical evolution, and organ donation outcomes were collected and analyzed. Results: Pediatric patients with BD or death by neurologic criteria discharged from pediatric hospitals in the Metropolitan Region (MR) of Santiago during 10 years of observation were successfully characterized. This type of death accounts for 6.5% of total deaths in the PICU (34 patients), with a low proportion of donors in this population (23%), reaching nearly a quarter of patients with death by neurologic criteria.