Paediatric and neonatal intensive care.

Abstract

The major objective of intensive care for infants and children is to provide maximum surveillance and support of organ systems during acute, but reversible, ]ire-threatening illness) In contrast to adult patients, there are fewer children admilted to intensive care unit~ (ICU's) who suffer from either chronic or degenerative organ system disorders. Although infants and children with chronic and severe debilitating neurologic and respiratory problems are increasing in prevalence in paediatric intensive care settings, still the majority of children admitted to these units have suffered from or are at high risk for developing a potentially reversible life-threatening illness or injury, which, if successfully treated, will restore the child to a normal, productive life. Recognizing the potential for productivity over a child's life expectancy of 50 to 70 years, the rationale for and the cost of paediatfic intensive care is probably justifiable, at least in Western societies. Although the principles of intensive care for infants and children are similar m those for adult intensive earn, the age spectrum from infancy through adolescence requires that the intensive care staff have special expertise in developmental physiology, pharmacology, and psychology. The paediatric intensive care team must be familiar with fetal and neonatal development of children to adulthood. In addition, an understanding of family dynamics and the responses of families to acute or chronic illness in children is essential in managing the complex parental behaviours that often arise during stressful times. The paediatrie ICU is generally considered a hospital unit that provide~ treatment to infants and children having or being at risk for a wide variety of illnesses of a lifethreatening nature. All critically ill children, regardless of diagnosis or subspecialty category, should be eohorted in units dedicated exclusively to children whenever possible. The precise age distribution and spectrum of illnesses will vary considerably from one paedialric ICU to another, on the basis of size, referral pattern, and the surgical activity of their respective hospitals at large.