Pediatric Intensive Care Medicine: Specialists and Information

Pediatric critical care medicine (critical care for children and adolescents) is a specialized branch within the field of pediatrics. It is responsible for providing critical care to critically ill children of all ages.

The field of neonatology (newborn medicine) is also part of pediatrics. It cares for newborns who, due to illness or premature birth, also require intensive care. Treatment takes place in specially equipped neonatal intensive care units and is provided by appropriately trained physicians and nurses.

Among other things, neonatal intensive care is necessary in cases of

• low birth weight,
• pulmonary hypoplasia (immature lungs),
• growth disorders during pregnancy,
• congenital anomalies,
• oxygen deprivation occurring during birth.

Pediatric intensive care units frequently treat the following conditions, among others:

• Injuries caused by accidents or other forms of violence (trauma),
• cardiovascular failure, for example due to congenital heart defects,
• sepsis (usually bacterial blood poisoning),
• severe meningitis (inflammation of the meninges, also usually caused by bacteria),
• other severe infections (viral or bacterial),
• acute respiratory distress syndrome,
• Before and after organ transplants.

Pediatric intensive care is recognized within the field of medicine as a distinct specialty. Here, children and adolescents of all ages receive treatment and care appropriate to their age. Not every hospital has a pediatric intensive care unit. Existing pediatric intensive care units are usually responsible for a large, supraregional catchment area.

Here, the distance between the unit and the operating room is also significantly shorter than in a “normal” pediatric ward, should surgery be necessary.

Only specially trained staff work in a pediatric intensive care unit. The treatment and care of critically ill children cannot be compared to the treatment of adults with the same clinical presentation. In addition, distinct clinical presentations arise in childhood or infancy that do not occur—or occur only rarely—in adulthood.

The smaller size of children and newborns also presents very specific challenges for staff and technical equipment. The difference in weight compared to adults must also be taken into account when caring for and treating children and adolescents.

Caring for children as patients requires special empathy © N Lawrenson/peopleimages.com | AdobeStock

Infants and toddlers, in particular, require special care tailored to the child’s stage of development. A baby or toddler is not yet able to communicate effectively. To make a diagnosis and determine further treatment, healthcare providers observe clinical signs. In addition, a thorough medical history and collaboration with the parents are essential.

During painful procedures (such as catheter insertion or blood draws), the patient needs a supportive and empathetic caregiver. This person must know how to handle such situations beyond their medical expertise.

For this reason, doctors and nurses in a pediatric intensive care unit (ICU) usually also receive training in education and psychology. This benefits not only the child but also you as parents: Having a child in the ICU places an enormous emotional and logistical burden on parents as well.

If your child needs to be treated in the pediatric intensive care unit, the first impression may be frightening. This is usually due to what is known as “monitoring”—that is, the continuous monitoring of your child’s vital signs. Monitoring is carried out using technical devices that are employed to ensure safe intensive care on this unit.

The basic equipment in a pediatric intensive care unit with an attached neonatology unit includes:

• special intensive care beds for the care of newborns,
• height-adjustable beds for infants,
• heat sources for premature and newborn infants,
• monitoring devices for tracking vital signs, as well as electronic connections for additional devices,
• so-called infusion pumps for the intravenous administration of medications and nutritional solutions.

1. Monitoring of vital signs: The most important vital signs include respiration and cardiovascular function. Therefore, your child will first be connected to an appropriate device. For this purpose, several ECG electrodes will be attached to their chest. On the monitor, nursing staff and doctors can read and interpret these functions in the form of a graph.
2. Body temperature measurement: Body temperature is continuously monitored via a probe.
3. Measuring oxygen levels: The nurse attaches a reddish-glowing electrode to the hand (and sometimes to the foot in the case of newborns). It measures the oxygen level in the blood and transmits the readings to the monitor as well.
4. Dual blood pressure monitoring: Blood pressure is also continuously monitored. To do this, the nurse places a cuff on your child. In addition, a small cannula in the crook of the arm or groin provides information about arterial blood pressure. If necessary, blood can be drawn through this catheter at any time.
5. Ventilators: Appropriate ventilators are available for artificial (invasive and non-invasive) ventilation.

If artificial ventilation is necessary, the doctor will insert a tube (endotracheal tube) through your child’s nose or mouth into the trachea. The tube is connected to a ventilator. If secretions build up and interfere with breathing, they are suctioned out.

During artificial ventilation, the child cannot eat or drink on their own. Therefore, in this case, they will receive a feeding tube through which they are provided with adequate nutrition. For this purpose, a thin tube is inserted through the nose and down to the stomach.

In an acute emergency, you’ll likely have little time to search for a pediatric intensive care unit. In such cases, the ambulance or emergency physician will take your child to the nearest hospital with a pediatric intensive care unit.

In most cases, intensive care is an emergency anyway. If, for reasons relevant to you, you are considering transferring your child to a different hospital, your child’s condition must be taken into account.

Therefore, plan a transfer to another hospital with great care and discuss it with the treating physicians.

If your child needs to be cared for in a pediatric intensive care unit, this is a major challenge in every respect. Nevertheless, your child is in the best possible care here. Specially trained doctors and nurses use state-of-the-art technology to care for your child 24 hours a day until they are ready to leave the pediatric intensive care unit.