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In 1981, the Report of the Medical Consultants on the Diagnosis of Death established guidelines for the diagnosis of brain death and, in 1995, the American Academy of Neurology published practice parameters to standardize determination of brain death. In 1987, the American Academy of Pediatrics established guidelines for determining brain death in children. Despite the establishment of these guidelines, the declaration of "death" based on the cessation of brain function remains complex and controversial. In this review are discussed the current guiding principles and the controversies in the diagnosis of brain death in children.

My challenge here is to convey the lessons I have learned in serving as a mentor to budding physicianscientists; yet, this is not as easy as it seems at first blush for at least two reasons. First, so many outstanding scientists, including Nobel laureates, have extolled the virtues of their own mentors who were central to their success. Thus, it feels pretentious to explain how to be a mentor, as if I have now reached some Olympian stature. Furthermore, I realize that those who might at first glance at this article have already thought about the topic throughout their career and acknowledged its importance. I certainly do not wish to provide obvious and unneeded advice.

Coma following a hypoxic-ischemic event is a serious condition and common reason for admission to the pediatric intensive care unit. Because coma has a high rate of mortality and morbidity in children, and the clinician may be unsure of the outcome very early in the course, it is important to have strategies to define prognosis. Although most studies have been conducted in adults, we review factors predicting outcome from coma of nontraumatic causes in infants and children. We consider the relation between physical findings, commonly accessible laboratory tools, and outcome, and comment on some newer techniques that may become more available for clinical purposes.