Neurodevelopmental care across pediatric critical care settings: toward brain-focused critical care

Advances in neonatal and pediatric critical care have expanded the focus from short‑term survival to include greater attention to long‑term neurodevelopmental health and family well‑being. This narrative review synthesizes the evolution of neurodevelopmental and neuroprotective care across neonatal (NICU), pediatric (PICU), and cardiovascular (CVICU/PCICU) intensive care settings. Developmental care emerged in the NICU through individualized, cue‑based approaches such as the Newborn Individualized Developmental Care and Assessment Program (NIDCAP), emphasizing stress reduction, protection of sleep, optimized sensory environments, and parent-infant coregulation. As survivorship after critical illness improved, parallel concerns about post‑intensive care morbidities, including cognitive, behavioral, and functional impairments, catalyzed adoption of family‑centered and brain‑focused practices in the PICU, supported by contemporary guidelines integrating pain and sedation optimization, delirium prevention, environmental stewardship, and early mobility. More recently, dedicated cardiac neurodevelopmental programs have adapted NICU principles to the high‑acuity CVICU/PCICU population, pairing hemodynamic vigilance with developmental goals through structured interdisciplinary models (e.g., developmental rounds, holding protocols, early therapy, feeding support, and caregiver mental health resources). Across settings, common implementation domains include family partnership, cue‑based care, protected sleep and circadian support, sensory modulation, humane pain and sedation strategies, early rehabilitation, and coordinated follow‑up after discharge.

While the strength of evidence varies by unit type and outcome, available data support feasibility and potential benefits for delirium reduction, functional recovery, feeding, parent experience, and early developmental trajectories. Continued multicenter research and implementation science are needed to define optimal bundles, equity‑informed delivery, and durable long‑term outcomes.

• Neurodevelopmental care is well established in NICUs, emphasizing cue-based care, pain reduction, environmental protection, and family partnership. • Survivors of pediatric and cardiac critical illness remain at risk for cognitive, behavioral, emotional, and functional impairments.

• This review extends neurodevelopmental care beyond the NICU to PICU and CVICU settings. • It proposes a unified multidisciplinary framework for brain-focused critical care across pediatric ICU environments.