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Arsenic exposure in adults has been associated with increased serum matrix metalloproteinase-9 (MMP-9), a biomarker which is associated with chronic respiratory disease, lung inflammation, cardiovascular disease and cancer. The objective of this study was to evaluate the association between serum MMP-9 levels in children, urinary arsenic, arsenic chronic daily intake (CDI) and arsenic exposure from playground dust. This cross-sectional study examined 127 children from five elementary schools, in Hermosillo, Sonora, Mexico. Arsenic was analyzed in the dust using a portable X-ray fluorescence (XRF) analyzer. Total urinary arsenic was determined by inductively coupled plasma/optical emission spectrometry. Serum was analyzed for MMP-9 using ELISA. Arsenic levels in playground dust averaged 16.9 ± 4.6 mg/kg. Urinary arsenic averaged 34.9 ± 17.1 µg/L. Arsenic concentration in playground dust was positively associated with serum MMP-9 levels in crude analyses and after adjustment (P < 0.01), MMP-9 and CDI were positively associated only after adjustment (P < 0.01), and no association was found between MMP-9 and urinary arsenic. In conclusion, our study showed an association in children between serum MMP-9 levels and playground dust arsenic concentrations. Therefore, exposure to arsenic in dust where children spend significant time may manifest toxic effects.
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Arsênio/toxicidade , Poeira , Biomarcadores Ambientais , Poluentes Ambientais/toxicidade , Metaloproteinase 9 da Matriz/sangue , Adolescente , Arsênio/urina , Criança , Pré-Escolar , Estudos Transversais , Poeira/análise , Exposição Ambiental/análise , Poluentes Ambientais/urina , Feminino , Humanos , Masculino , México , Instituições AcadêmicasRESUMO
INTRODUCTION: Children 5 and younger are at risk for sustaining serious burn injuries. The causes of burns vary depending on demographic, cultural and socioeconomic variables. At this pediatric burn center we provided medical care to children from Mexico with severe injuries. The purpose of this study was to understand the impact of demographic distribution and modifiable risk factors of burns in young children to help guide prevention. METHODS: A retrospective chart review was performed with children 5 and younger from Mexico who were injured from 2000-2013. The medical records of 447 acute patients were reviewed. Frequency counts and percentages were used to identify geographic distribution and calculate incidence of burns. Microsoft Powermap software was used to create a geographical map of Mexico based on types of burns. A binomial logistic regression was used to model the incidence of flame burns as opposed to scald burns in each state with relation to population density and poverty percentage. In all statistical tests, alpha=0.05 for a 95% level of confidence. RESULTS: Burns were primarily caused by flame and scald injuries. Admissions from flame injuries were mainly from explosions of propane tanks and gas lines and house fires. Flame injuries were predominantly from the states of Jalisco, Chihuahua, and Distrito Federal. Scalds were attributed to falling in large containers of hot water or food on the ground, and spills of hot liquids. Scald injuries were largely from the states of Oaxaca, Distrito Federal, and Hidalgo. The odds of a patient having flame burns were significantly associated with poverty percentage (p<0.0001) and population density (p=0.0085). Increasing levels of poverty led to decrease in odds of a flame burn, but an increase in the odds of scald burns. Similarly, we found that increasing population density led to a decrease in the odds of a flame burn, but an increase in the odds of a scald burn. CONCLUSIONS: Burns in young children from Mexico who received medical care at this pediatric burn center were attributed to flame and scalds. Potential demographic associations have been identified. Different states in Mexico have diverse cultural and socioeconomic variables that may influence the etiology of burns in young children and this information may help efficiently tailor burn prevention campaigns for burn prevention efforts in each region. APPLICABILITY OF RESEARCH TO PRACTICE: This information will be used to develop and help modify existing prevention campaigns.
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Queimaduras/epidemiologia , Densidade Demográfica , Pobreza/estatística & dados numéricos , Unidades de Queimados , Pré-Escolar , Explosões/estatística & dados numéricos , Feminino , Incêndios/estatística & dados numéricos , Humanos , Incidência , Lactente , Modelos Logísticos , Masculino , México/epidemiologia , Razão de Chances , Estudos Retrospectivos , Fatores Socioeconômicos , Estados UnidosRESUMO
AIMS: To describe early progress of the Healthier You: NHS Diabetes Prevention Programme, a behavioural intervention designed to prevent or delay onset of Type 2 diabetes in people in England already identified to be at high risk, to assess numbers of referrals received by Programme providers and the proportion that attended the initial assessment, and to identify the factors associated with attendance rates. METHODS: These analyses examine the data for referrals received between June 2016 and March 2017. RESULTS: There were 43 603 referrals received, 16% higher than expected. Of those referred, 49% attended the initial assessment, higher than the 40% modelled uptake. Of those referred, there was no significant difference in uptake by sex (P=0.061); however, attendance per 100 000 population varied significantly by sex, age group, ethnicity and deprivation; it was significantly lower for men (P<0.001), higher as age increased (P<0.001) and higher for individuals from Asian, Afro-Caribbean, mixed and other ethnic groups compared with individuals from white European groups (P<0.001). There was significant interaction between attendance rates by ethnicity and deprivation (P<0.001) such that attendance rates were significantly higher in the most deprived quintile vs the least deprived quintile for Asian, Afro-Caribbean, mixed and other ethnic groups but not significantly different for white European ethnic groups. CONCLUSION: The analyses show that referral numbers and percentage uptake are in excess of prior modelled values. Characteristics of attendees suggest that the programme is reaching those who are both at greater risk of developing Type 2 diabetes and who typically access healthcare less effectively.
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Terapia Comportamental/estatística & dados numéricos , Diabetes Mellitus Tipo 2/prevenção & controle , Adulto , Idoso , Ásia/etnologia , Diabetes Mellitus Tipo 2/etnologia , Inglaterra/epidemiologia , Utilização de Instalações e Serviços , Feminino , Promoção da Saúde/estatística & dados numéricos , Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Encaminhamento e Consulta/estatística & dados numéricos , Medicina Estatal/estatística & dados numéricos , Índias Ocidentais/etnologia , População Branca/etnologiaRESUMO
INTRODUCTION: Young children are the most vulnerable for sustaining burns. At this pediatric burn hospital we have provided medical care to young children with severe burns from Mexico for many years. This study identified modifiable risk factors that could be used to assist in prevention of burns in this age group. METHODS: A retrospective chart review was performed with children <5 years of age from Mexico who were injured from 2000 to 2013. The medical records of 447 acute patients were reviewed. RESULTS: There were 187 females and 260 males with large burns >20% total body surface area (TBSA) burned. Primary causes of burns were flame and scalds. Children with flame injuries were older (3.0±1.5 years of age) than those with scalds (2.6±1.2 years of age). Admissions attributed to flame burns were largely from explosions by propane tanks, gas line leaks, and house fires. Most admissions for scalds were predominantly from falling in large containers of hot water, food, or grease; and fewer were attributed to spills from hot liquids. Most cases reported to a social service agency were to find resources for families. Mortality rate for flame and scald burns was low. CONCLUSIONS: It is important take into account demographic, cultural, and socioeconomic variables when developing and implementing prevention programs. Burn prevention instruction for parents is crucial.
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Queimaduras/epidemiologia , Explosões , Incêndios , Acidentes por Quedas , Acidentes Domésticos/prevenção & controle , Superfície Corporal , Unidades de Queimados , Queimaduras/etiologia , Queimaduras/prevenção & controle , Pré-Escolar , Feminino , Hospitais , Humanos , Lactente , Recém-Nascido , Masculino , México/etnologia , Estudos Retrospectivos , Estados Unidos/epidemiologiaRESUMO
BACKGROUND: We sought to establish an anesthetic protocol to evaluate the hemodynamic, metabolic, and electrolytic changes after graft reperfusion in pigs undergoing orthotopic intestinal transplant (ITx). METHODS: Fifteen pigs were distributed into two groups: GI (n = 6), without immunosuppression, and GII (n = 9), immunosuppressed before surgery with tacrolimus (0.3 mg/kg). The animals were premedicated at 1 hour before surgery with IM acepromazine (0.1 mg/kg), morphine (0.4 mg/kg), ketamine (10 mg/kg), and atropine (0.044 mg/kg IM). Anesthesia induction used equal proportions of diazepam and ketamine (0.1-0.15 mL/kg/IV) and for maintenance in IV infusion of xylazine (1 mg/mL), ketamine (2 mg/mL), and guaiacol glyceryl ether 5% (50 mg/mL), diluted in 250 mL of 5% glucose solution. In addition, recipient pigs were treated with isofluorane inhalation. Heart rate (HR), systolic (SAP), mean (MAP), and diastolic (DAP) arterial pressure, pulse oximetry, respiratory frequency (f), capnography, body temperature (T), blood gas analysis (pH, Paco(2), Pao(2), base excess, BE; Hco(3)(-), Sato(2)), serum potassium (K), calcium (Ca), sodium, hematocrit (Hct), and glucose (Glu) were measured at four times; M0: after incision (basal value); M1: 10 minutes before reperfusion; and M2 and M3: 10 and 20 minutes after graft reperfusion. RESULTS: All groups behaved in a similar pattern. There was significant hypotension after graft reperfusion in GI and GII (M2 = 56.2 +/- 6.4 and M3 = 57.2 +/- 8.3 mm Hg and M2 = 65.7 +/- 10.2 and M3 = 67.8 +/- 16.8 mm Hg, respectively), accompanied by elevated HR. The ETco(2) was elevated at M2 (42 mm Hg) and M3 (40 mm Hg). Metabolic acidosis was observed after reperfusion, with significant increase in K levels. CONCLUSION: The anesthetic protocol for donors and recipients was safe to perform the procedure, allowing control of hemodynamic and metabolic changes after reperfusion without differences regarding immunosuppression.
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Intestino Delgado/transplante , Animais , Glicemia/metabolismo , Pressão Sanguínea/efeitos dos fármacos , Cálcio/sangue , Frequência Cardíaca/efeitos dos fármacos , Hematócrito , Hemodinâmica , Hipotensão/epidemiologia , Imunossupressores/uso terapêutico , Modelos Animais , Oximetria , Potássio/sangue , Reperfusão , Traumatismo por Reperfusão/fisiopatologia , Respiração Artificial , Suínos , Tacrolimo/uso terapêuticoRESUMO
OBJECTIVE: To demonstrate the ability of a submaximal test to predict VO(2max) in overweight children. STUDY DESIGN: A total of 130 children, 11 to 14 years old, with body mass index >85 percentile for age and sex performed a submaximal walking test. VO(2max) was measured by using open circuit spirometry during a graded exercise test to volitional fatigue. An equation to predict VO(2max) was modeled by using the variables of sex, weight (kg), height (cm), heart rate (HR) after 4 minutes during the submaximal test (4minHR), HR difference (4minHR - resting HR), and submaximal treadmill speed (miles per hour [mph]) in 75% of the subjects. Validation was performed by using the remaining 25% of subjects. RESULTS: A total of 113 subjects achieved a maximal effort and was used in the statistical analysis. Development and validation groups were similar in all aspects. On validation, the mean square error was 241.06 with the predicted VO(2max) within 10% of the observed value in 67% of subjects. CONCLUSION: VO(2max) was accurately predicted in this cohort of overweight children by using a submaximal, treadmill-based testing protocol.
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Teste de Esforço , Sobrepeso/fisiopatologia , Consumo de Oxigênio/fisiologia , Adolescente , Estatura , Índice de Massa Corporal , Peso Corporal , Criança , Feminino , Frequência Cardíaca/fisiologia , Humanos , Masculino , Modelos Biológicos , Fatores Sexuais , EspirometriaRESUMO
OBJECTIVE: We studied the relationship between % body fat (%BF), cardiovascular fitness (CVF), and insulin resistance (IR) in overweight middle-school children. STUDY DESIGN: Middle school children (n = 106, body mass index [BMI] > 95th percentile for age) underwent evaluation of body composition, maximal volume of oxygen utilization (VO2) uptake/kg lean body mass (VO2max/kgLBM), and fasting glucose and insulin (FI) concentrations and derived homeostasis model assessment index (HOMA(IR)). RESULTS: Both %BF (r = .33, P < .001) and VO2max/kgLBM (r = -0.42, P < .0001) were significantly correlated with FI. Bivariate regression analysis revealed %BF (P = .008 vs FI, P = .035 vs HOMA(IR)) and VO2max/kgLBM (P < .001 vs FI, P = .009 vs HOMA(IR)) to be independent predictors of insulin sensitivity. In males, VO2max/kgLBM was a better predictor of FI and HOMA(IR) than %BF. CONCLUSIONS: In obese middle-school children, both %BF and VO2max/kgLBM are independent predictors of FI levels. The relationship between CVF and FI levels was significant in both sexes but was particularly profound and stronger than %BF in males. Efforts to reduce risk of type 2 diabetes mellitus in an increasingly obese child population should include exercise intervention sustained enough to improve CVF.
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Adiposidade , Insulina/sangue , Obesidade/metabolismo , Aptidão Física , Glicemia/metabolismo , Índice de Massa Corporal , Criança , Jejum , Feminino , Humanos , Resistência à Insulina , Modelos Logísticos , Masculino , Análise Multivariada , Obesidade/diagnóstico , Consumo de Oxigênio , Fatores SexuaisRESUMO
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OBJECTIVE: Our purpose was to determine whether there exists a mortality difference between neonates treated with Infasurf (surfactant A [SA], ONY, Inc, Amherst, NY) and Survanta (surfactant B [SB], Ross Products Division, Abbott Laboratories, Columbus, OH). METHODS: We evaluated 114 different neonatal units' records, between January 1, 2000, and December 31, 2000, of neonates < or = 36 weeks' estimated gestational age who were admitted for neonatal intensive care and reported to have been treated with SA or SB. We used stepwise logistic regression analysis to determine whether the type of surfactant was associated with increased incidence of neonatal death, severe intraventricular hemorrhage, or necrotizing enterocolitis independent of estimated gestational age, birth weight, sex, method of delivery, use of antenatal steroids, or place of birth. RESULTS: We studied the records of 5169 neonates; 1115 (22%) received SA and 4054 (78%) received SB. The most important variables associated with neonatal death, intraventricular hemorrhage and necrotizing enterocolitis were birth weight and estimated gestational age. Logistic regression showed that the type of surfactant did not significantly influence any of these 3 outcomes. Neither overall mortality (8.3% vs 8.5%) or birth weight-specific mortality was different between the 2 groups. CONCLUSION: The differences in mortality previously reported are not present in a larger, more contemporary data set.
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Produtos Biológicos , Avaliação de Processos e Resultados em Cuidados de Saúde , Surfactantes Pulmonares/uso terapêutico , Síndrome do Desconforto Respiratório do Recém-Nascido/tratamento farmacológico , Síndrome do Desconforto Respiratório do Recém-Nascido/mortalidade , Peso ao Nascer , Feminino , Idade Gestacional , Humanos , Mortalidade Infantil , Recém-Nascido , Terapia Intensiva Neonatal , Tempo de Internação , Masculino , Análise Multivariada , Análise de Regressão , Estudos Retrospectivos , Taxa de SobrevidaRESUMO
OBJECTIVE: To determine if neonatal intensive care at higher altitudes was associated with any variation in mortality or morbidity. METHODS: We reviewed demographic and outcome data on 5450 neonates with birth weights between 500 and 1500 g cared for in 76 different level II and III neonatal intensive care units (NICUs). The altitude break point of 4300 feet was prospectively chosen. Care was provided at 63 NICUs located below 4300 feet, "low-altitude," (n = 4534 neonates) and at 13 NICUs at or above 4300 feet, "high-altitude" (n = 916 neonates). RESULTS: Compared with neonates cared for at low altitude, neonates cared for at high altitude were more often non-Hispanic white and exposed to prenatal steroids. Neonates born at high altitude were more often treated with surfactant (60% vs 53%, P <.01). At 28 days of age, neonates cared for at high altitude were less often in room air (33% vs 50%, P <.01) compared with neonates cared for at low altitude. However, when corrected for barometric pressure, the calculated partial pressure of inspired oxygen at 28 days of age was lower for neonates cared for at high altitude compared with low altitude (165 +/- 80 vs 183 +/- 57, P <.01). There were no differences in the rates of mortality, severe intraventricular hemorrhage (grades 3 and 4), severe retinopathy of prematurity (stages 3 and 4), or necrotizing enterocolitis requiring surgical treatment. CONCLUSIONS: Being cared for at NICUs located above 4300 feet above sea level was not associated with any increase in adverse events compared with NICUs located below 4300 feet.
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Altitude , Cuidados Críticos , Recém-Nascido de muito Baixo Peso , Feminino , Humanos , Recém-Nascido , Unidades de Terapia Intensiva Neonatal , Masculino , Morbidade , Análise Multivariada , Estudos RetrospectivosAssuntos
Recém-Nascido Prematuro/crescimento & desenvolvimento , Respiração Artificial/efeitos adversos , Síndrome do Desconforto Respiratório do Recém-Nascido/etiologia , Síndrome do Desconforto Respiratório do Recém-Nascido/prevenção & controle , Humanos , Recém-Nascido , Recém-Nascido de muito Baixo Peso/crescimento & desenvolvimento , Pulmão/crescimento & desenvolvimento , Pulmão/fisiopatologia , Síndrome do Desconforto Respiratório do Recém-Nascido/fisiopatologia , Fatores de TempoRESUMO
PURPOSE: To identify current factors associated with home apnea monitor use in preterm infants and to determine whether home monitor use was associated with a shorter length of hospital stay. SETTING: We evaluated neonates who were < or =34 weeks' estimated gestational age and admitted for neonatal intensive care. We excluded neonates with congenital anomalies, neonates transferred out before discharge, and neonates who died. METHODS: Using a database created with a computer-assisted tool that generates hospital notes, we reviewed the epidemiology of monitor use. Differences between neonates sent home with an apnea monitor and those who were not were evaluated by using stepwise logistic regression analysis to identify which factors were independently associated with a neonate being discharged with a monitor. RESULTS: We studied 14,532 neonates; 1588 (11%) were sent home with monitors and 12,944 (89%) were not. The most important variables associated with being discharged with a monitor were site of care and a diagnosis of apnea. Site variation remained significant when adjusted for gestational age, diagnosis of apnea, and a history of use of methylxanthines. When corrected for gestational age, monitor use was not associated with shorter hospital stays. CONCLUSION: The data suggest that monitor use is more dependent on physician preference than medical indication and is not associated with earlier hospital discharge.
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Apneia/tratamento farmacológico , Recém-Nascido Prematuro , Unidades de Terapia Intensiva Neonatal , Alta do Paciente , Polissonografia , Xantinas/uso terapêutico , Índice de Apgar , Peso ao Nascer , Estudos Transversais , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Tempo de Internação , Modelos Logísticos , MasculinoRESUMO
If CC chemokine receptor 5 (CCR5)-dependent mechanisms at the time of initial virus exposure are important determinants of virus entry and disease outcome, then the polymorphisms in CCR5 that influence risk of transmission and disease progression should be similar; this hypothesis was tested in a cohort of 649 Argentinean children exposed perinatally to human immunodeficiency virus type 1 (HIV-1). Two lines of evidence support this hypothesis. First, CCR5 haplotype pairs associated with enhanced risk of transmission were the chief predictors of a faster disease course. Second, some of the haplotype pairs associated with altered rates of transmission and disease progression in children were similar to those that we previously found influenced outcome in European American adults. This concordance suggests that CCR5 haplotypes may serve as genetic rheostats that influence events occurring shortly after initial virus exposure, dictating not only virus entry but, by extension, also the extent of early viral replication.
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Infecções por HIV/transmissão , HIV-1 , Transmissão Vertical de Doenças Infecciosas , Receptores CCR5/genética , Síndrome da Imunodeficiência Adquirida/transmissão , Argentina , Estudos de Coortes , Progressão da Doença , Feminino , Variação Genética , Genótipo , Infecções por HIV/genética , Infecções por HIV/virologia , Haplótipos , Humanos , Lactente , Gravidez , Complicações Infecciosas na Gravidez/virologiaRESUMO
BACKGROUND: Excitotoxicity is an important mechanism in secondary neuronal injury after traumatic brain injury (TBI). Excitatory amino acids (EAAs) are increased in cerebrospinal fluid (CSF) in adults after TBI; however, studies in pediatric head trauma are lacking. We hypothesized that CSF glutamate, aspartate, and glycine would be increased after TBI in children and that these increases would be associated with age, child abuse, poor outcome, and cerebral ischemia. METHODS: EAAs were measured in 66 CSF samples from 18 children after severe TBI. Control samples were obtained from 19 children who received lumbar punctures to rule out meningitis. RESULTS: Peak and mean CSF glycine and peak CSF glutamate levels were increased versus control values. Subgroups of patients with TBI were compared by using univariate regression analysis. Massive increases in CSF glutamate were found in children <4 years old and in child abuse victims. Increased CSF glutamate and glycine were associated with poor outcome. A trend toward an association between high glutamate concentration and ischemic blood flow was observed. CONCLUSIONS: CSF EAAs are increased in infants and children with severe TBI. Young age and child abuse were associated with extremely high CSF glutamate concentrations after TBI. A possible role for excitotoxicity after pediatric TBI is supported.
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Ácido Aspártico/líquido cefalorraquidiano , Lesões Encefálicas/líquido cefalorraquidiano , Lesões Encefálicas/etiologia , Ventrículos Cerebrais , Maus-Tratos Infantis , Aminoácidos Excitatórios/líquido cefalorraquidiano , Ácido Glutâmico/líquido cefalorraquidiano , Glicina/líquido cefalorraquidiano , Adolescente , Fatores Etários , Lesões Encefálicas/diagnóstico por imagem , Lesões Encefálicas/mortalidade , Isquemia Encefálica/etiologia , Estudos de Casos e Controles , Criança , Maus-Tratos Infantis/estatística & dados numéricos , Pré-Escolar , Pessoas com Deficiência/estatística & dados numéricos , Escala de Coma de Glasgow , Escala de Resultado de Glasgow , Humanos , Lactente , Prognóstico , Análise de Sobrevida , Fatores de Tempo , Tomografia Computadorizada por Raios XRESUMO
OBJECTIVE: To evaluate the consistency of pediatric asthma care with the National Asthma Education and Prevention Program Guidelines. DESIGN: Cross-sectional survey at 2 managed care organizations in the United States (winter 1997-1998). The participants were parents of children (n = 318) age 5 to 17 years with asthma. There were no interventions. The outcome measures were indicators of care in 4 domains: (1) periodic physiologic assessment, (2) proper use of medications, (3) patient education, and (4) control of factors contributing to asthma severity. RESULTS: Of 533 eligible patients with asthma, 318 (60%) parents responded; 59% of children were male, 76% were white, and 60% were aged 5 to 10 years. Deficiencies in care were identified in all care domains including, for patients with moderate and severe persistent symptoms, only 55% used long-term control medication daily, 49% had written instructions for handling asthma attacks, 44% had instructions for adjustment of medication before exposures, 56% had undergone allergy testing, and 54% had undergone pulmonary function testing. CONCLUSIONS: There are significant opportunities to improve the quality of care for children with asthma enrolled in managed care. A comprehensive approach to improving care may be necessary to address multiple aspects of care where opportunities exist.
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Asma/terapia , Fidelidade a Diretrizes/normas , Programas de Assistência Gerenciada/normas , Pediatria/normas , Guias de Prática Clínica como Assunto , Qualidade da Assistência à Saúde , Adolescente , Asma/diagnóstico , Asma/etiologia , Atitude Frente a Saúde , Criança , Pré-Escolar , Estudos Transversais , Feminino , Fidelidade a Diretrizes/estatística & dados numéricos , Pesquisa sobre Serviços de Saúde , Humanos , Masculino , Programas de Assistência Gerenciada/estatística & dados numéricos , Meio-Oeste dos Estados Unidos , Avaliação das Necessidades/organização & administração , New England , Avaliação de Resultados em Cuidados de Saúde , Pais/educação , Pais/psicologia , Educação de Pacientes como Assunto/normas , Pediatria/métodos , Pediatria/estatística & dados numéricos , Indicadores de Qualidade em Assistência à Saúde , Índice de Gravidade de Doença , Inquéritos e Questionários , Gestão da Qualidade Total/organização & administraçãoRESUMO
OBJECTIVES: To determine whether bcl-2, a protein that inhibits apoptosis, would be increased in cerebrospinal fluid (CSF) in infants and children after traumatic brain injury (TBI) and to examine the association of bcl-2 concentration with clinical variables. STUDY DESIGN: Bcl-2 was measured in CSF from 23 children (aged 2 months-16 years) with severe TBI and from 19 children without TBI or meningitis (control subjects) by enzyme-linked immunosorbent assay. CSF oligonucleosome concentration was also determined as a marker of DNA degradation. Brain samples from 2 patients undergoing emergent decompressive craniectomies were analyzed for bcl-2 with Western blot and for DNA fragmentation with TUNEL (terminal deoxynucleotidyl-transferase mediated biotin-dUTP nick-end labeling). RESULTS: CSF bcl-2 concentrations were increased in patients with TBI versus control subjects (P =.01). Bcl-2 was increased in patients with TBI who survived versus those who died (P =.02). CSF oligonucleosome concentration tended to be increased after TBI (P =.07) and was not associated with bcl-2. Brain tissue samples showed an increase in bcl-2 in patients with TBI versus adult brain bank control samples and evidence of DNA fragmentation within cells with apoptotic morphology. CONCLUSIONS: Bcl-2 may participate in the regulation of cell death after TBI in infants and children. The increase in bcl-2 seen in patients who survived is consistent with a protective role for this anti-apoptotic protein after TBI.