Why do we need a children’s ICU, called Paediatric ICU (PICU)

By Dr. Chandra Sekhar Singha

Children are special, they are the future of the nation. So, we have to ensure that children falling sick are given the best possible medical care. Unfortunately, even in a multi-speciality hospital in India, children’s needs are not properly addressed today.

Children need a special environment, according to their developmental stage. A Paediatric Intensive Care is where critically ill children can be treated to make them better and give them better quality of life for the future.

Children can be very sick when their important organ system are involved in any disease process. If they have a problem of breathing, abnormal blood pressure, or brain issues, it is very serious. If we are not able to fix it in appropriate time, they may lose their life.

If we are not able to give them quality care, they may survive, but future outcome may not be good. They may survive with neurological disabilities, learning problem, or may be totally dependent on artificial support.

When children fall sick, they can be treated at home with oral medication, or they may need hospital admission for minimal support or given medication through intravenous line. But if children become very sick, they will need advanced support to support their breathing and cardiovascular system, and to maintain brain function. That is a challenging job which needs highly trained doctors, nurses and sophisticated machines which can support them till their body recovers. When children are extremely sick, there is a risk of death if we are not able to intervene in the appropriate time. They need close and vigilant monitoring.

Children are not like adult. Children do not have enough reserve in their body, sick children can deteriorate very quickly. That is the reason they need close monitoring and intervention in appropriate time to prevent death, and improve quality of life.

When children are very sick and admitted in Paediatric Intensive Care Unit (PICU). They will get better, or sometimes we lose them. We lose them for following reasons: 

• • procedure related complication
• • hospital acquired infection
• • not intervening in appropriate time 
• • misdiagnosis
• • treatment failure

By ensuring to provide quality of care we can prevent most of the deaths, except in the case of treatment failure. When the child is critically sick, if we are not able to provide support in appropriate time, there is high chance of treatment failure. There are some diseases which do not have any treatment. In such cases, we can only provide comfort care and support their organ systems for however long they live. Sometimes it is very important to know the diagnosis of disease, especially if the child is suffering from some genetic disease to prevent recurrence in future pregnancy.

Why we need a Paediatric ICU or Children’s hospital? 

1. Children are a fast-growing; we need different sizes of instrument depending on their size and weight. For example, to take a blood pressure, we need different cuff size.
2. To measure oxygen level, we need different size of pulse oximetry probe.
3. Children’s drug doses are very small, so we need precise calculation before delivery.
4. Setting up an IV line and taking blood sample from small baby needs training and patience because their tiny veins are difficult to locate. Sometime we use special vein-finder instruments to locate the veins.
5. Children with complex medical problem needs different speciality services, which are easily available in children’s hospital in all the time or in case of emergency in short notice.

For example, when we suspect that the child is suffering from wheat allergy, after preliminary examination, he or she may need an endoscopy – a special camera is introduced through food pipe to take a picture, and a small tissue sample for pathological examination, so we can quickly establish the diagnosis and start the treatment.  

6. During routine or operation procedure, we take care of their needs so that they don’t feel threatened before the operation.
7. We allow the parents to stay with the child till the time the child gets anaesthesia for the operation

These things cannot be done in an adult multi-speciality hospital because of time constraint, inappropriate environment and insufficient manpower who understand the need of children. In a PICU, Children Super Specialist doctors are available all the time, and all cases are managed by child specialists, including 24 X 7 emergency services.

This article was published in partnership with Rainbow Children’s Hospital.

Dr. Chandra Sekhar Singha
MBBS, MD- PEDIATRICS, FELLOWSHIP IN PEDIATRIC CRITICAL CARE
Consultant Pediatrician
Madhukar Rainbow Children’s Hospital, Delhi