Spotlight: Focus on Pediatric Trauma and Critical Illness

critically ill child surrounded by hospital staff Hospital staff attend to a child in bed in the pediatric critical care ward, while the child’s mother stands by the bed
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In recognition of Critical Care Awareness Month, we focus on NICHD’s Pediatric Trauma and Critical Illness Branch (PTCIB), which supports a portfolio of research on preventing, treating, and reducing all forms of child abuse, trauma, injury, and critical illness.

As we mark 5 years since the branch was established, we highlight research accomplishments in key areas, including injury prevention and pediatric critical care.

Pediatric Trauma  

A focus area for the branch is research on trauma and its impact on child health and development. For example, studies of the biology of stress show how traumatic experiences, such as extreme poverty or exposure to violence, abuse, or neglect can affect cognitive, social, emotional, physiological, and physical health.

  • An NICHD-funded Duke University study focuses on the neuropsychological (cognitive, emotional, and behavioral) and genetic signatures of exposure to violence in childhood. Research has found that exposure to trauma and violence in early life has long-term effects on health, including gene function.
  • A similar study at Butler Hospital in Providence, RI, focuses on child maltreatment experiences in early childhood and their long-term health effects. The research first studies the children at preschool age and then follows them up 5 years later when the youngsters are between 8 to 10 years old. Results may provide insight into how maltreatment influences the risk of depression, anxiety, and other poor health outcomes.

Pediatric Injuries

According to the Centers for Disease Control and Prevention, unintentional injury is the leading cause of death and disability among U.S. children. PTCIB supports several research projects to better understand injuries stemming from teen driving, accidents, and violence-related injury.  

Pediatric Critical Care

Severe infections, heart and lung diseases, traumatic brain and other serious injuries are just a few of the reasons a child may go to the pediatric intensive care unit (PICU). We know that children are not just little adults, so understanding the specific needs and treatments for children in the PICU is important to improving survival and long-term health.

  • Because of the nature of the PICU, communication is vital not only among health care providers, but also between parents and providers. Parents often make life-changing decisions for their seriously ill child and need to understand the issues and the possible results. One NICHD-funded study is assessing a parental engagement intervention curriculum for PICU providers to determine its effectiveness in increasing understanding and satisfaction among parents. The findings could provide a framework for improving communication in all PICUs.
  • It is standard practice for PICU patients on breathing machines to be sedated to help provide compassionate and safe care. However, little is known about the long-term effects of sedation on a child’s developing brain. An NICHD-funded study is examining the relationship between sedatives given in the PICU and long-term neurocognitive outcomes.
  • Although the field of pediatric critical care is relatively young, research has helped improve care and outcomes. As more and more critically ill children are surviving, scientists aim to understand how emerging treatments affect the long-term quality of life for these children. PTCIB’s research portfolio includes projects that aim to fill those gaps and provide knowledge to inform critical care decisions. For example:
    • Information is lacking to correlate severity of injury or illness with morbidity—having a disease or symptoms of a disease—after patients leave the PICU. Morbidity can include mental and physical impairments, heart and lung problems, and other issues that may result either from the illness/injury itself or from treatment that helps the child survive. NICHD-funded researchers developed the Functional Status Scale to provide data about children’s outcomes during and after PICU stays.
    • Another multicenter study is examining health outcomes for children who were treated for sepsis, a life-threatening blood infection. Researchers are exploring long-lasting measures to ensure a productive life for these children after leaving the PICU.

PTCIB helps focus research attention and resources on issues specific to caring for children who are seriously ill and injured. The branch will continue its work to promote discoveries, find new treatments, and test interventions that improve the quality of life for children and families well into the future.

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