Defining Pediatric Chronic Critical Illness for Clinical Care, Research, and Policy

Area of Science:

• Pediatrics
• Critical Care Medicine
• Neonatology

Background:

• Chronically critically ill pediatric patients are an emerging population in neonatal intensive care units (NICUs) and pediatric intensive care units (PICUs).
• Chronic critical illness is well-defined in adults, but lacks systematic attention and definition in pediatrics.
• Understanding pediatric chronic critical illness is crucial for improving care and outcomes.

Purpose of the Study:

• To review current knowledge on pediatric chronic critical illness.
• To highlight unique aspects of this condition in infants and children.
• To propose a definition and research agenda for pediatric chronic critical illness.

Main Methods:

• Literature review of existing knowledge on pediatric chronic critical illness.
• Analysis of unique prognostic factors, outcomes, and decision-making considerations.
• Development of a proposed definition incorporating key clinical and developmental factors.

Main Results:

• Pediatric chronic critical illness presents unique challenges compared to adults.
• A proposed definition includes factors like NICU/PICU stay duration, recurrent admissions, technology dependence, multiorgan dysfunction, medical complexity, and developmental implications.
• Significant knowledge gaps exist in clinical care, research, and policy.

Conclusions:

• A clear definition of pediatric chronic critical illness is needed.
• The proposed definition encompasses critical aspects of prolonged pediatric critical illness.
• Further research and policy development are essential to address the needs of these patients.