Abstract
Currently nearly one-quarter of admissions to pediatric intensive care units (PICUs)
worldwide are for neurocritical care diagnoses that are associated with significant
morbidity and mortality. Pediatric neurocritical care is a rapidly evolving field
with unique challenges due to not only age-related responses to primary neurologic
insults and their treatments but also the rarity of pediatric neurocritical care conditions
at any given institution. The structure of pediatric neurocritical care services therefore
is most commonly a collaborative model where critical care medicine physicians coordinate
care and are supported by a multidisciplinary team of pediatric subspecialists, including
neurologists. While pediatric neurocritical care lies at the intersection between
critical care and the neurosciences, this narrative review focuses on the most common
clinical scenarios encountered by pediatric neurologists as consultants in the PICU
and synthesizes the recent evidence, best practices, and ongoing research in these
cases. We provide an in-depth review of (1) the evaluation and management of abnormal
movements (seizures/status epilepticus and status dystonicus); (2) acute weakness
and paralysis (focusing on pediatric stroke and select pediatric neuroimmune conditions);
(3) neuromonitoring modalities using a pathophysiology-driven approach; (4) neuroprotective
strategies for which there is evidence (e.g., pediatric severe traumatic brain injury,
post–cardiac arrest care, and ischemic stroke and hemorrhagic stroke); and (5) best
practices for neuroprognostication in pediatric traumatic brain injury, cardiac arrest,
and disorders of consciousness, with highlights of the 2023 updates on Brain Death/Death
by Neurological Criteria. Our review of the current state of pediatric neurocritical
care from the viewpoint of what a pediatric neurologist in the PICU needs to know
is intended to improve knowledge for providers at the bedside with the goal of better
patient care and outcomes.
Keywords
pediatrics - critical care medicine - status epilepticus - status dystonicus - stroke
- neuroimmunology - neuromonitoring - neuroprognostication - brain death
