The correct approach to diagnosing brain death in a neonate (especially with a temperature of 36°C, which is within the acceptable range for testing) involves clinical neurological examinations and apnea testing, while ancillary tests (like EEG or duplex ultrasound) may be used in specific cases but are not primary diagnostic criteria.

Correct Answer:

1. Failure of respiratory drive after disconnection from MV (mechanical ventilation), increased PCO₂ to ≥ 8 kPa (60 mmHg)

Explanation:

Brain death diagnosis in neonates requires strict clinical criteria, including:

1. Prerequisites

• Normalized temperature (≥ 36°C, as in this case).

• Exclusion of hypotension, metabolic disturbances, or drug effects (e.g., sedatives).

2. Clinical Examination (Essential)

• Absence of brainstem reflexes:

• c. Corneal reflex (absent in brain death)

• d. Motor response to painful stimulation (absent in brain death)

• Apnea test (Most critical):

• Disconnect from ventilator, allow PCO₂ to rise to ≥ 8 kPa (60 mmHg).

• No respiratory effort confirms failure of respiratory drive (a).

3. Ancillary Tests (Not Primary, but Used if Clinical Exam Inconclusive)

• b. EEG (electrocerebral silence supports diagnosis, but not required if clinical exam is conclusive)

• e. Cerebral duplex ultrasound (may show absent flow, but less definitive than clinical exam)

Why Other Options Are Incorrect?

• b. EEG – Not mandatory unless clinical testing is impossible (e.g., severe facial trauma).

• e. Cerebral duplex ultrasound – Helpful but not definitive for brain death diagnosis.

• c & d – These are part of brainstem reflex testing, but apnea testing (a) is required for final confirmation.

Key Takeaway:

• Apnea testing (a) is mandatory for diagnosing brain death in neonates.

• Brainstem reflexes (c, d) must also be absent.

• Ancillary tests (b, e) are secondary and used only if clinical exams cannot be completed.

Source:

• UK Guidelines (NICE) and American Academy of Pediatrics (AAP) protocols for neonatal brain death determination.