Pediatrics
From newborn to adolescent
Age-banded normative values for hemodynamics, ICP, CPP, TCD, NIRS, NPi, and ONSD. Every cell carries a citation and an evidence chip, most pediatric MNM data are grade C or sparse, and we say so.
In children
Sparseness disclaimer. Pediatric MNM normative values are derived from heterogeneous populations and small studies. The figures below are working clinical defaults , individualize with autoregulation indices when you can.
| Parameter | Newborn (0–1 mo) | Infant (1–12 mo) | Toddler (1–3 yr) | Preschool (3–6 yr) | School-age (6–12 yr) | Adolescent (13–18 yr) |
|---|---|---|---|---|---|---|
Heart rate (awake) bpm | 100–205 Expertpals2020 | 90–180 Expertpals2020 | 80–140 Expertpals2020 | 65–120 Expertpals2020 | 60–110 Expertpals2020 | 50–100 Expertpals2020 |
Systolic BP mmHg | 60–80 Expertpals2020 | 70–100 Expertpals2020 | 80–110 Expertpals2020 | 90–115 Expertpals2020 | 95–120 Expertpals2020 | 100–130 Expertpals2020 |
MAP minimum target mmHg | ≥ 35–40 Expertpals2020 | ≥ 40–50 Expertpals2020 | ≥ 50–55 Expertpals2020 | ≥ 55–60 Expertpals2020 | ≥ 60–65 Expertpals2020 | ≥ 65–70 Expertpals2020 |
ICP, normal mmHg | < 6 Sparsetasker2023 | < 8 Sparsetasker2023 | < 10 Ckochanek2019 | < 10 Ckochanek2019 | < 15 Ckochanek2019 | < 15 Bkochanek2019 |
ICP, treatment threshold mmHg | > 10 Sparsetasker2023 | > 15 Sparsetasker2023 | > 20 Ckochanek2019 | > 20 Ckochanek2019 | > 20 Ckochanek2019 | > 20 Bkochanek2019 |
CPP minimum target mmHg | 30–40 Sparsekochanek2019 | 40–50 Sparsekochanek2019 | 40–50 Ckochanek2019 | 50–55 Ckochanek2019 | 50–60 Ckochanek2019 | 60–70 Bkochanek2019 |
TCD MCA mean flow velocity cm/s | ~24 Cobrien2015 | 40–80 Cobrien2015 | 80–100 Cobrien2015 | 90–110 Cobrien2015 | 85–95 Cobrien2015 | 60–80 Cobrien2015 |
NIRS rSO₂ % Asymmetry > 10–15 % is clinically significant in any age group. | 65–85 ⚠ < 55 Ahyttel2015 | 60–80 ⚠ < 50 Ckurth2009 | 60–80 ⚠ < 50 Ckurth2009 | 60–80 ⚠ < 50 Ckurth2009 | 60–80 ⚠ < 50 Ckurth2009 | 60–75 ⚠ < 50 Ckurth2009 |
ONSD upper bound mm | < 4.0 ⚠ > 4.5 Cpadayachy2012 | < 4.0 ⚠ > 4.5 Cpadayachy2012 | < 4.5 ⚠ > 5.0 Cpadayachy2012 | < 4.5 ⚠ > 5.0 Cpadayachy2012 | < 4.5 ⚠ > 5.0 Cpadayachy2012 | < 5.7 ⚠ > 6.0 Brobba2018 |
NPi 0–5 Sedation depresses NPi; estimate ~((40 − BIS)/40) × 0.8 reduction when BIS < 40. | 3.0–5.0 ⚠ < 3 Expertolson2016 | 3.0–5.0 ⚠ < 3 Expertolson2016 | 3.0–5.0 ⚠ < 3 Expertolson2016 | 3.0–5.0 ⚠ < 3 Expertolson2016 | 3.0–5.0 ⚠ < 3 Expertolson2016 | 3.0–5.0 ⚠ < 3 Expertolson2016 |
PaCO₂,normocapnia mmHg Avoid prophylactic hyperventilation (PaCO₂ > 30). Brief PaCO₂ 30–35 acceptable for impending herniation. | 35–45 Expertkochanek2019 | 35–40 Expertkochanek2019 | 35–40 Expertkochanek2019 | 35–40 Expertkochanek2019 | 35–40 Expertkochanek2019 | 35–40 Expertkochanek2019 |
Age-specific physiology
Read the chapter
See pediatric cerebral physiology for an in-depth tour of how the brain changes from term newborn to adolescent.
When to escalate
Pediatric TBI guidelines
The Kochanek 2019 guidelines set the canonical thresholds for pediatric severe TBI.