Neuro-critical Care

What is Pediatric Neurocritical Care?

Elbert John Layug, MD

Last edited: September 26, 2025

Pediatric Neurocritical Care (PNCC) is a specialized area of medicine focused on protecting and supporting the brain in critically ill babies and children. It combines intensive care with neurology to help prevent further brain injury, monitor brain function, and improve long-term outcomes.

Why is it Important?

Brain at Risk: The brain in newborns and children is very vulnerable. Even when the main illness is in the heart, lungs, or another organ, the brain can be affected.
High Impact: Around 1 in 4 children admitted to a PICU have a neurological problem, and these conditions are a major cause of death and disability in children.
Long-Term Effects: Early brain injuries can lead to cerebral palsy, epilepsy, developmental delays, or learning and behavior challenges if not managed carefully.

Neurocritical Care in the NICU (Newborn Intensive Care Unit)

Focuses on newborns, especially those who are premature or had a difficult birth.

Common brain-related problems include:

Lack of oxygen at birth (hypoxic-ischemic encephalopathy, HIE)
Seizures
Stroke or brain bleeding
Brain malformations

Tools and strategies used:

Cooling therapy (therapeutic hypothermia) for babies with HIE to protect the brain.
Continuous brain monitoring using special EEGs (brain wave tests) at the bedside.
MRI scans to see early brain injury.
Strict control of temperature, blood sugar, oxygen, and blood pressure to avoid making brain injury worse.

Care is provided by a team: neonatologists, neurologists, nurses, therapists, and social workers, all working together with the family.

Neurocritical Care in the PICU (Pediatric Intensive Care Unit)

Focuses on infants, children, and adolescents with acute brain problems.

Common reasons for PNCC in the PICU include:

Severe traumatic brain injury (after accidents or falls)
Status epilepticus (seizures that won’t stop)
Stroke (arterial or venous clots, or bleeding)
Neuroimmune diseases (like Guillain-Barré syndrome or inflammation of the brain and spinal cord)
Brain swelling after cardiac arrest or infection

Tools and strategies used:

Continuous EEG monitoring to detect hidden seizures.
Advanced neuromonitoring (checking brain oxygen, blood flow, and pressure).
Neuroprotective care such as avoiding fever, controlling blood pressure, treating seizures quickly, and sometimes using deep sedation or coma for protection.
Rapid imaging (CT, MRI) to detect strokes, bleeding, or swelling.

Care is delivered by multidisciplinary teams: critical care doctors, neurologists, neurosurgeons, radiologists, rehabilitation specialists, and nurses.

The Big Picture

Goal: Prevent secondary brain injury and give the developing brain the best chance to recover.

Approach: Multidisciplinary teamwork, specialized monitoring, and family-centered care.

Future: PNCC is still growing as a specialty, and not every hospital has a dedicated service yet.

Research continues to improve treatments, monitoring, and outcomes.

In simple terms...

Pediatric Neuro-critical Care is about protecting young brains when kids are critically ill—whether they’re fragile newborns in the NICU or older children in the PICU. By combining brain-focused care with intensive support for the rest of the body, doctors aim to give these children the best possible future.