Pediatric Neurocritical Care

Abstract

Pediatric neurocritical care is an emerging multidisciplinary field of medicine and a new frontier in pediatric critical care and pediatric neurology. Central to pediatric neurocritical care is the goal of improving outcomes in critically ill pediatric patients with neurological illness or injury and limiting secondary brain injury through optimal critical care delivery and the support of brain function. There is a pressing need for evidence based guidelines in pediatric neurocritical care, notably in pediatric traumatic brain injury and pediatric stroke. These diseases have distinct clinical and pathophysiological features that distinguish them from their adult counterparts and prevent the direct translation of the adult experience to pediatric patients. Increased attention is also being paid to the broader application of neuromonitoring and neuroprotective strategies in the pediatric intensive care unit, in both primary neurological and primary non-neurological disease states. Although much can be learned from the adult experience, there are important differences in the critically ill pediatric population and in the circumstances that surround the emergence of neurocritical care in pediatrics.

Building a Pediatric Neurocritical Care Program: A Multidisciplinary Approach to Clinical Practice and Education from the Intensive Care Unit to the Outpatient Clinic

“…There have been a number of reports and position articles on the practice of pediatric neurocritical care or inpatient neurology at academic medical centers in the United States [1][2][3][4][5][6] and recent proposals on the training required for a pediatric neurointensivist. 3,[7][8][9] Here we describe our specific 10-year experience developing the Ruth D. & Ken M. Davee pediatric neurocritical care program at Northwestern University Feinberg School of Medicine, including long-term follow-up of intensive care unit (ICU) patients in a dedicated neurocritical care follow-up clinic.…”

Serum amyloid A is increased in children with abusive head trauma: a gel-based proteomic analysis

“…a busive head trauma (AHT) (e.g., shaken baby syndrome) is the leading cause of death from child abuse and the leading cause of death from traumatic brain injury (TBI) in infants and young children (1)(2)(3)(4)(5)(6)(7). More than 20% of TBI and 80% of all deaths due to TBI in children less than 2 y of age are the result of AHT (8)(9)(10).…”

Guiding Principles for a Pediatric Neurology ICU (neuroPICU) Bedside Multimodal Monitor

“…Pediatric neurocritical care is an emerging discipline that focuses on the care of children with serious acute neurologic diseases, such as traumatic brain injury, unremitting seizures (status epilepticus), and intracranial hemorrhage [1][2][3]. Caring for these patients demands that physicians integrate multiple sources of complex data in real time at the bedside [4].…”

“…Several hurdles prevent full use of available clinical data at the point of care. For example, (1) the volume of data itself can be overwhelming [6]; (2) some of the data, EEG in particular, requires complex interpretation by physicians who are usually not at the bedside; (3) the data are collected via multiple proprietary devices; and (4) pediatric neurocritical care is a recently developed field, with only a small cadre of bona fide experts and few evidence-based recommendations to define the standard of care [1][2][3].…”