Pediatric Neuro-Critical Care Service

Overview

The Pediatric Neuro-Critical Care Service at Mass General for Children is a specialty consultation service embedded within the Pediatric Intensive Care Unit (PICU). Critically ill children and adolescents requiring intensive care can be at risk for neurologic injury. Working closely with intensivists as well as other pediatric sub-specialists within the PICU, our focus is on treating patients with primary neurological injuries and illnesses and protecting the brain in all cases of critical illness. We treat a wide range of conditions, including:

• Traumatic brain injury
• Stroke
• Status epilepticus
• Patient who have had a cardiac arrest
• Sepsis
• Multi-organ system failure
• Shock
• Hypoxia and ischemic brain injuries
• Liver failure
• Spinal cord or peripheral nerve conditions
• Patients who have undergone neurosurgical procedures (brain tumors, hydrocephalus, congenital anomalies, epilepsy surgery, spine surgery, etc.)

We have a multidisciplinary approach that includes a team of pediatric neurologists, pediatric neurosurgeons, pediatric neuroradiologists, pediatric neuro-oncologists, pediatric trauma specialists, and specialists in pediatric neurocritical care.

Combined Resources

Pediatric Neuro-Critical Care at Mass General for Children combines the expertise of physicians board-certified in Pediatric Critical Care Medicine, pediatric neurology and neuro-critical care with the neuroscience resources of Mass General. Massachusetts General Hospital consistently ranks as one of the top neurology and neurosurgery departments in the nation, according to the U.S. News & World Report.

Extensive Experience

Mass General has a well-developed pediatric stroke program with extensive expertise in acute stroke management in older children and adolescents, strokes in neonates and infants, and brain imaging evaluation of stroke and cervico-cranial vascular disorders.

Our team also has a special focus on neurologic trauma. We are a lead site in several national and international clinical trials for pediatric head injury (the TRACK TBI and ADAPT studies). Our faculty members give frequent lectures on trauma and stroke at many national and international meetings. Additionally, a number of our staff in both Critical Care and Neurosurgery lead laboratory research efforts in traumatic brain injury in children, and can provide the most up-to-date translational treatments from bench to bedside.

Research

Neuro-Critical care for children is different from adult neurocritical care and our research focuses on the unique needs of children. We are currently conducting clinical research into the efficacy of a new coma scale, developed by the chief of Pediatric Neurosurgery at Mass General for Children, which is specific to children and applicable to pre-verbal children. Other research includes:

• Monitoring for non-convulsive seizures in patients with traumatic brain injury
• Infection and stroke risk in pediatric patients
• Application of NIRS Near infrared spectroscopy monitoring for brain perfusion in critical illness
• Secondary mechanisms of acute brain injury including in trauma and intracerebral hemorrhage
• Cerebral malaria
• Blood brain barrier research
• Brain trauma – the TRACK TBI and ADAPT studies
• Auditory Brainstem Implant trial (with Massachusetts Eye and Ear Institute) – this is a trial of a new type of implanted device in the brain which is designed for children who have profound deafness to enable them to hear

Our program is also participating in an international registry of pediatric stroke patients collecting data to help understand risk factors related to pediatric stroke. In addition, we are participating in national prospective observational studies of treatment and outcome in pediatric traumatic brain injury.