Chapter 76
- Pediatric and Neonatal Intensive Care
- W. Daniel Kovarik
The major objective of pediatric intensive care is to provide
maximum surveillance and support of vital systems in infants and children with acute,
reversible, life-threatening disease. In contrast to adult patients, few children
admitted to a pediatric intensive care unit (PICU) suffer from chronic or degenerative
organ system disorders. Most of these children have a potentially reversible life-threatening
illness or injury that if successfully treated, will restore the child to a normal,
productive life.[1]
Although the principles of intensive care for children are similar
to those for adults, the age spectrum from infancy through adolescence requires that
the intensive care staff have special expertise in developmental physiology and psychology.
The pediatric intensive care team must be familiar with fetal and neonatal cardiopulmonary
physiology, as well as the physiologic and psychological aspects of growth and development
to adulthood. All critically ill children, regardless of diagnosis or subspecialty
category, should be placed in units dedicated to children. Specific guidelines describing
minimum criteria for PICUs and services have been published.[2]
Beginning in 1985, the American Board of Pediatrics officially recognized the subspecialty
of pediatric critical care medicine.
When matched for severity of illness, pediatric patients cared
for in PICUs have decreased mortality in comparison to those cared for by physicians
without pediatric intensive care training in non-tertiary care facilities.[3]
Hospitals without sufficient numbers of pediatric patients to provide specialized
facilities for pediatric intensive care should consider transferring critically ill
children to a regional PICU. It is the obligation of regional PICUs to develop transport
systems that will facilitate the safe and timely transport of critically ill children
to the referral center. In addition, the regional center should provide medical
education in emergency and critical care pediatrics to primary care and referring
physicians and nurses.[4]
