Pediatric neurocritical care and neuro-oncology in Brazil: ten-year experience at a reference unit

Pediatric neurocritical care (PNC) has emerged as a specialized field aimed at improving outcomes for children with neurological conditions. Despite advances, pediatric neuro-oncology remains underrepresented within PNC literature.

To describe the clinical and severity profiles of children admitted over a decade to a Pediatric Neurocritical Care Unit (PNCU) at the Instituto do Cérebro Paulo Niemeyer (IECPN), with special focus on patients with central nervous system (CNS) tumors.

This retrospective, descriptive observational study included patients admitted to the PNCU from September 2013 to August 2023. Demographic, clinical, and severity data were collected, ICU and hospital length of stay, mortality, and discharge disposition. Comparative analyses were performed between patients with and without CNS tumors.

A total of 1079 admissions were analyzed, with a median age of 6 years. Most admissions were surgical, predominantly for tumor resection (34%). Patients with CNS tumors (n = 436) were older (median 8 vs. 4 years), had more frequent intracranial mass effect (8.5% vs. 2.9%) and had longer ICU (7 vs. 6 days) and hospital stays (8 vs. 6 days), although mortality did not differ significantly. Astrocytomas, medulloblastomas, and ependymomas were the most common tumor types. Kaplan-Meier analysis showed no significant difference in ICU survival between groups.

Children with CNS tumors present distinct clinical characteristics and require longer ICU and hospital care, with higher use of invasive devices, but without increased mortality. These findings underscore the complexity of neuro-oncological care in pediatric neurocritical settings and highlight the importance of tailored multidisciplinary management strategies.