Updates in Pediatrics
Editor: Jack Wolfsdorf, MD, FAAP

header with photos of various children
November 2, 2022 | Volume 13 | Issue 44
Hyperbaric oxygen therapy in children with post-concussion syndrome
As many as 2 million children in the US experience mild traumatic brain injury (MTBI – concussion) every year with <10% of them losing consciousness during the episode. MTBI can lead to a variety of physical, emotional and cognitive symptoms (headaches, nausea, dizziness, difficulty paying attention at school etc.) which normally improve within 1 to 2 weeks. “A minority of children will experience symptoms for >4 weeks; sometimes called “post-concussion syndrome”. Persistent post-concussion syndrome (PPCS) occurs in 10-30% lasting months to years.

Guidelines for early management of acute concussion recommend limited periods of rest followed by gradual return to school and other activities. “Existing evidence for effective PPCS treatment remains limited”.

In adults, hyperbaric oxygen therapy (HBOT) has been shown to be beneficial in PPCS (through tissue oxygenation, anti-inflammatory action, angiogenesis and enhanced restoration, number/function of mitochondria). This therapy has not been evaluated in children with PPCS.

From a randomized, sham-controlled, double-blind prospective trial of HBOT in PPCS children with ongoing symptoms for 6 months following TBI, it appears that HBOT significantly improves cognitive function, behavioral symptoms (and executive function and attention difficulties) and quality of life with improved brain microstructure on brain imaging.
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