High Hopes for Blood Biomarkers to Diagnose Brain Injury in Young Children

About half of the kids who have abusive head trauma are totally well-appearing kids, and I think people have this perception of the child with abusive head trauma in the ICU with monitors all over; but just like other types of traumatic brain injury, there is a wide variety, and children range from looking completely normal to being completely comatose. So unfortunately, you can't be comforted that the child doesn't have a brain injury just because they look well. I think for parents, I don't know that there's too much you can do as a parent if you think someone has hurt your child or you're concerned about a caretaker. Clearly that's something you need to bring up with the medical care provider because otherwise most providers--medical care providers would not think to look at the brain because the vast majority of infants they're going to see-- who are fussy or who are vomiting--don't have a brain injury. And that's one of the problems that we've been trying to address for the last decade, really, has been--is there a panel of brain biomarkers that would allow a parent to say, "Could you get this blood test?" Or for a doctor to say, "Let's get this blood test," and if it's negative, you could feel much better; and if it's positive you would then go ahead and do an image of the brain. We've been trying to develop a panel of biomarkers that doctors or other paraprofessionals could use in an emergency room setting to identify the needle in the haystack--essentially to allow them to point to the brain, and we do this in all of our organ systems. If you go into the emergency room and you say I have chest pain, probably the first thing they're going to do is draw your blood and see whether it's from your heart or whether it's just from just a muscle or another source of the pain. So, we'd like to be able to do that same thing. We've had a lot of success previously, and we're currently--well, we hope to be one of the definitive studies. We have a study which is in 3 centers in the United States, and we enrolling almost 1,000 infants who we would consider to be at increased risk of having a brain injury-- not necessarily a child abuse brain injury, but any kind of brain injury. Because they're coming for medical care because they're fussy, because they're irritable. They don't have a fever, and they don't have any history of trauma. And our goal is to see whether these brain biomarkers-- in addition to some other clinical variables like checking a blood count, checking how large the baby's head is-- other things that we know from experience may be related to having a brain injury. So, hopefully in the next--we have 3 more years left of the study. Hopefully by the end of that we'll have a really good sense of whether this test is going to be able to be brought to clinical care.

Pediatrician Rachel Berger talks about her research on blood biomarkers that could be used in the emergency setting to test for brain injury in babies and young children.

See more videos with Dr. Rachel Berger.

Rachel Berger

Rachel Berger MD, MPH is part of the Child Advocacy Center at Children’s Hospital of Pittsburgh and a member of the hospital’s Child Protection Team. She has been involved in the evaluation of thousands of children with suspected child abuse and neglect.

Posted on BrainLine January 9, 2013.

Produced by Victoria Tilney McDonough and Jared Schaubert, BrainLine, and Dan Edblom.