Tag Archives: pediatric

PEGASUS Takes Flight for Kids with Brain Injuries

Winged horse merged with a glowing brain and neural patterns against a cosmic background

When a child arrives at an ICU with severe traumatic brain injury, every minute counts and every decision matters. That’s exactly the problem the Pediatric Guideline Adherence and Outcomes (PEGASUS) program was built to solve.

Developed in 2011 at the Harborview Medical Center, a Level I Trauma Center affiliated with the University of Washington School of Medicine, PEGASUS was created to close the so-called “know-do” gap, translating Brain Trauma Foundation guidelines into bedside practice. The program trains key staff, redesigns workflows, and provides ongoing coaching.

Published in Critical Care Medicine on March 27, 2026, a new study shows the model can reach far beyond Seattle. Across 16 hospitals in Argentina, Chile, and Paraguay, children with isolated severe traumatic brain injury at PEGASUS hospitals showed 8 percentage points higher guideline adherence than those receiving standard care. This determination came from the first randomized trial of an implementation science approach to improving care in adult or pediatric traumatic brain injury.

The reach of PEGASUS is backed by federal investment: the study was supported by a grant from the U.S. National Institute of Neurological Disorders and Stroke. As Dr. Monica Vavilala of UW Medicine clarified, this approach can be adopted by hospitals around the world, whether or not they are Level I Trauma Centers.

Genetic “Light Switch” Could Turn Off Pediatric Brain Injury

“Epigenetics refers to how your behaviors and environment can cause changes that affect the way your genes work,” reports the CDC. As defined by the NIH National Cancer Institute, a methyl group is, “a small molecule made of one carbon and three hydrogen atoms.” Epigenetic changes can include DNA methylation: this addition of the methyl group to cytosine. (Cytosine is, “chemical compound that is used to make one of the building blocks of DNA and RNA,” notes the NCI.) These modifications, that turn genes “on” or “off” without altering DNA itself, act as a cranial “light switch”, as they, “encode a member of the nerve growth factor family of proteins… promoting binding of this protein to its cognate receptor promotes neuronal survival in the adult brain.”

It may be difficult to fully understand how the aforementioned scientific information relates directly to brain injury, but recent study results further lay out the benefits of DNA methylation in recovery. In December 2025, University of Pittsburgh researchers published findings in the Journal of Neurotrauma related to epigenetics and brain injury. Led by Dr. Lacey Heinsberg and Dr. Amery Treble-Barna, the study examined nearly 300 children at UPMC Children’s Hospital, discovering that children with traumatic brain injuries showed significantly lower DNA methylation of the BDNF gene (Brain-Derived Neurotrophic Factor) compared to children with orthopedic injuries. 

Encouragingly, these negative changes appear reversible. “DNA methylation is dynamic and modifiable, which means it could respond to interventions like diet, exercise and therapy,” Dr. Heinsberg noted. These findings open doors for personalized rehabilitation strategies that could actively improve recovery for children with brain injuries.