Clinical Characteristics, Critical Care Interventions and Outcomes of Paediatric Neuro-Intensive Care Unit Admissions - A Retrospective Cohort Study

Clinical Characteristics, Critical Care Interventions and Outcomes of Paediatric Neuro-Intensive Care Unit Admissions - A Retrospective Cohort Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Clinical Characteristics, Critical Care Interventions and Outcomes of Paediatric Neuro-Intensive Care Unit Admissions - A Retrospective Cohort Study Amrutha Nirale, Tejaswi GM, Kamath Sriganesh, Shafaq Malik, MR Shubha Shree, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6225486/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 9 You are reading this latest preprint version Abstract Purpose There is limited literature regarding the burden, management and outcomes of children managed in the neuro-intensive care unit (NICU). Increasing paediatric NICU admissions presents a huge challenge in developing countries like India. The critical care interventions (CCIs) and clinical outcomes of children with neurological and neurosurgical pathologies may vary but are currently unknown. This study aimed to assess the incidence of paediatric NICU admission and compare the clinical characteristics, NICU management and clinical outcomes between paediatric neurological and neurosurgical populations in the NICU. Methods This retrospective observational study was conducted after institute ethics committee approval and involved children aged < 18 years admitted to the NICU of a tertiary care academic neurosciences hospital between January to December 2023. Results About 8% (90/1153) of NICU admissions were children. We observed significant differences in the number of CCIs during the NICU stay, duration of NICU stay, and the GCS score at NICU and hospital discharge between paediatric neurological and neurosurgical disorders. The frequency of CCIs correlated significantly with the duration of mechanical ventilation, NICU stay and hospital stay, and GCS score at NICU and hospital discharge. Conclusion Our study suggests that CCIs and clinical outcomes are different for paediatric neurological and neurosurgical patients, and the number of CCIs has a significant impact on clinical outcomes in children admitted to the NICU. Future studies should evaluate if a dedicated paediatric NICU influences outcomes in children with acute and severe neurological diseases. Paediatric neuro-intensive care unit Paediatric neurology Paediatric neurosurgery critical care interventions outcomes Figures Figure 1 Figure 2 Figure 3 INTRODUCTION Critically ill neurological patients requiring intensive care unit (ICU) admission are usually cared for in the neuro-intensive care unit (NICU). The care of these neurosurgical and neurological patients in the NICU differs from the general ICU.[ 1 ] The clinical outcomes, including mortality, are better in dedicated NICUs with trained neurointensivists than in the general ICUs.[ 2 , 3 ] Children with neurological illnesses requiring ICU care are managed alongside adults in NICUs or in paediatric ICUs in many hospitals. It is increasingly felt that children with neurological illnesses requiring NICU care may be served better with a dedicated pediatric neuro-critical care (PNCC) setup, considering the unique concerns of children.[ 4 ] While dedicated PNCC services exist in the United States of America (USA),[ 5 ] such facilities are lacking in the developing world, including India, which cater to a large paediatric population requiring neurocritical care. However, initiating PNCC services requires additional resources for reorganisation, as well as multi-disciplinary expertise involving paediatrics, paediatric neurology, paediatric neurosurgery, and neurocritical care. Therefore, before embarking on a change in practice, there is a need for robust data on paediatric NICU admissions, management practices and clinical outcomes in the existing scenario. Adult patients admitted to the NICU with neurosurgical and neurological diagnoses differ not only with regard to their clinical conditions but also with respect to outcomes.[ 6 ] Though there are no similar studies in children, it is likely that there may be differences in critical care interventions (CCI) and clinical outcomes in children with neurosurgical and neurological diagnoses. Therefore, it is necessary to understand the burden of paediatric NICU admissions in relation to the total NICU admissions and also evaluate CCI and outcomes among paediatric neurosurgical and neurological diagnoses. The primary objective of this study was to assess the incidence of paediatric NICU admissions in our NICU over a one-year period. Our secondary objectives were to assess indications for NICU admission, incidence and indications for re-admission to the NICU, NICU complications, the number and types of CCIs performed during the NICU stay and compare clinical characteristics and outcomes between children with neurosurgical and neurological diagnoses. We also aimed to assess the correlation between CCI in the NICU and patient-important outcomes in children with critical neurological and neurosurgical disorders. METHODS This retrospective observational study was conducted after institute ethics committee approval (No. NIMHANS/IEC/2023 dated 05.12.2023) and involved children aged < 18 years admitted to the NICU of a tertiary care academic neurosciences hospital between January to December 2023. The following data were collected from the patient healthcare records – name and hospital identification number (de-anonymised at analysis), age, gender, neurological and neurosurgical diagnosis, date of admission and discharge from the hospital, indication for NICU admission, type of surgery where relevant, date of NICU admission and discharge (NICU duration), presence of tracheal tube at NICU admission and discharge, indication for NICU admission (postoperative observation/monitoring, poor neurological status or neurological decline, respiratory insufficiency requiring intubation with or without mechanical ventilation, and cardiovascular compromise requiring haemodynamic support), Glasgow Coma Scale (GCS) score at NICU and hospital admission, and NICU complications. We collected the incidence and details of the following CCIs in the NICU - mechanical ventilation, central venous cannulation, arterial cannulation, intracranial pressure [ICP] monitoring, external ventricular drain placement, plasmapheresis, electroencephalogram monitoring, haemodynamic support administration, cardiopulmonary resuscitation, tracheostomy, and surgery/intervention. The data regarding the following outcomes were collected – duration of mechanical ventilation, duration of NICU and hospital stay, GCS score at NICU and hospital discharge, NICU readmission and in-hospital mortality. The intubated or tracheostomised patients were scored as 1 for verbal response in the GCS score assessment. No formal sample size calculation was performed for this exploratory study. The study data was analysed using the SPSS software, version 23. Interval and ordinal scale data are described using means and standard deviations or as medians and interquartile ranges, while categorical data are expressed as frequencies and percentages. Non-parametric Mann-Whitney U test was used to compare differences between neurosurgical and neurological patients for parameters that were ordinal or continuous but not normally distributed. The chi-square test was used to compare differences between the neurosurgical and neurological populations for categorical variables. We used Spearman’s correlation test to measure the strength and direction of the relationship between CCIs and patient outcomes. A p-value < 0.05 was considered statistically significant. RESULTS A total of 1,153 patients were admitted to the NICU during the study period from January to December 2023. Of these, 90 admissions were children accounting for 7.8% of the total NICU admissions. The demographic and baseline clinical characteristics are depicted in Table 1 . The median age of our overall study population was 12 years (4.5–14.5). There were more male children in the overall study sample and also in the neurosurgery group, while females were more in the neurology population. Table 1 Demographic and baseline clinical characteristics of the study population. Values are expressed as median and interquartile range for quantitative variables and number and percentage for qualitative variables. Parameters Overall (n = 90) Neurosurgery (n = 73) Neurology (n = 17) Age (years) 12 (4.5–14.5) 12 (1–14) 15 (11.5–16) Male gender 50 (55.56%) 43 (58.9%) 7 (41.18%) Diagnosis Neoplastic 41 (56.16%) Congenital 15 (20.55%) Vascular 7 (9.59%) Infective 6 (8.22%) Traumatic 4 (5.48%) Neuro-Muscular Disease 9 (52.94%) Seizures 4 (23.53%) Infective 4 (23.53%) GCS score at hospital admission 15 (14–15) 15 (14–15) 14 (11–15) GCS score at NICU admission 10 (7–11) 10 (7–11) 10 (6–11) Intubated at the ICU admission 71 (78.89%) 58 (79.45%) 13 (76.47%) GCS - Glasgow Coma Scale; NICU – Neuro Intensive Care Unit In our study, most children admitted to the NICU belonged to the neurosurgical speciality (73/90, 81.11%), with the rest having neurological diagnoses (17/90, 18.88%). Among the neurosurgical population, the most common diagnosis was cranial and spinal neoplastic lesions (56.16%), followed by congenital disorders (20.55%) such as atlantoaxial dislocation, craniosynostosis, hydrocephalus, and meningomyelocele. The less common neurosurgical diagnoses were vascular pathologies (9.59%) such as arterio-venous malformations and cerebral venous thrombosis, and brain infections (8.22%), such as cranial abscess, subdural empyema and postoperative ventriculitis, with least common being traumatic brain injury (TBI) (5.48%). Among the neurological diagnoses, the most common pathology was related to the peripheral nervous system (52.94%) and included Guillain-Barre syndrome (GBS), lower motor neuron syndrome, and hemiballismus. The less common neurological pathologies were neuroinfections (23.53%) and seizure disorders (23.53%). The median GCS score of our study population at the hospital and NICU admission were 15 and 10, respectively. Most children (71/90, 79%) were admitted to the NICU with their trachea already intubated. The indications for NICU admission were broadly categorised based on the system involved and postoperative aetiology and is depicted in Fig. 1 . The indications were post-operative observation in 47/90 (52.22%) children, focal or global neurological deterioration in 22/90 (24.44%), respiratory insufficiency in 17/90 (18.89%), and cardiovascular and haemodynamic compromise in 4/90 (4.44%) paediatric patients. Sixty-nine (76.67%) children did not develop complications during their stay in the NICU. The remaining children developed various complications, with some more than one complication, and these are depicted in Fig. 2 . There were 16 adverse haemodynamic events, seven respiratory complications, five new-onset neurological events, such as seizures and focal deficit, and one complication related to a procedure performed in the NICU. During their NICU stay, children underwent many CCIs as part of their NICU care. The most common CCI was mechanical ventilation, and the least common was invasive ICP monitoring. The details of all the CCIs are depicted in Fig. 3 . The comparison between children with neurosurgical and neurological diagnoses for various clinical outcomes is depicted in Table 2 . The number of CCIs (p = 0.004), duration of ICU stay (p = 0.018), GCS score at NICU discharge (p = 0.005) and GCS score at hospital discharge (p = 0.011) were significantly different between neurosurgical and neurological populations. The children with neurological diagnoses underwent more CCIs, had a longer NICU stay, and had a lower GCS score at NICU and hospital discharge compared to children with neurosurgical diagnoses. The NICU readmission rates and in-hospital mortality were, however, not statistically significant. Table 2 Clinically important patient outcomes in children admitted to the Neuro Intensive Care Unit. Variables are expressed as median and interquartile range or as number and percentage. Outcomes Overall (n = 90) Neurosurgery (n = 73) Neurology (n = 17) P value Number of CCIs 2 (0–4) 1 (0–3) 5 (3–9) 0.004 Duration of NICU stay (days) 4 (2–11) 4 (2–6.5) 14 (3.5–23.5) 0.018 Duration of hospital stay (days) 18.5 (12–28.75) 17 (11.5–27.5) 26 (16–63.5) 0.106 Duration of ventilation (days) 3 (1–6) 3 (1–5) 6 (2–19) 0.068 GCS score at NICU discharge 15 (11–15) 15 (12–15) 11 (8–15) 0.005 GCS score at hospital discharge 15 (15–15) 15 (15–15) 13 (11–15) 0.011 NICU re-admission 5/90 (5.56%) 3/73 (4.11%) 2/17 (11.77%) 0.237 In-hospital mortality 10/90 (11.11%) 6/73 (8.22%) 4/17 (23.53%) 0.090 CCI - Critical Care Intervention; GCS - Glasgow Coma Scale; NICU – Neuro Intensive Care Unit The influence of CCIs on patient outcomes is depicted in Table 3 . The CCIs significantly influenced the patient outcomes (P < 0.001). The frequency of CCIs had a moderate positive correlation with outcomes such as the duration of hospital and NICU stay and duration of mechanical ventilation. On the other hand, outcomes such as GCS score at NICU and hospital discharge had a moderate negative correlation with the number of CCIs. Table 3 Correlation between the cumulative Critical Care Interventions score and patient outcomes in children admitted to the Neuro Intensive Care Unit. CCI Duration of NICU stay Duration of hospital stay Duration of mechanical ventilation GCS score at NICU discharge GCS score at hospital discharge Correlation coefficient 0.606 0.378 0.533 -0.449 -0.502 P value < 0.001 < 0.001 < 0.001 < 0.001 < 0.001 CCI - Critical Care Interventions; GCS - Glasgow Coma Scale; NICU - Neuro Intensive Care Unit DISCUSSION This study evaluated the burden of paediatric NICU admissions in a neurosciences tertiary care academic hospital from India, compared the outcomes among paediatric neurosurgical and neurological populations and investigated the correlation between CCIs in NICU and clinical outcomes in children with neurological and neurosurgical disorders. In our study, about 8% of the NICU admissions were children requiring PNCC services. Significant differences were noted between neurosurgical and neurological diagnoses in the children admitted to the NICU for the number of CCIs during the NICU stay, duration of NICU stay, and GCS score at NICU and hospital discharge. The number of CCIs correlated significantly and positively with the duration of mechanical ventilation, NICU stay and hospital stay, and significantly and negatively with the GCS score at NICU and hospital discharge. An earlier study demonstrated that dedicated PNCC units have reduced mortality after paediatric TBI.[ 7 ] This underscores the role of a dedicated monitoring and care system for this vulnerable population of children with acute neurological illness. However, studies evaluating the impact of paediatric NICU admissions are lacking. The existing literature compares outcomes among adult neurological patients managed in the general ICU versus the NICU. These studies documented better outcomes with dedicated NICU admissions.[ 2 , 3 ] For children, the literature predominantly focuses on ICU requirements as a proportion of all paediatric hospital admissions.[ 8 ] In contrast, our study determined the burden of children requiring NICU admission as a proportion of total NICU admissions. The proportion of paediatric NICU admissions is significant to consider curated care pathways for age-specific specialised monitoring and equipment, skilled and trained personnel, and interdisciplinary care systems appropriate for children with acute neurological disorders for better decision-making and holistic patient management to improve outcomes. The indications of paediatric admissions to the NICU may differ from those of their adult counterparts. The common indications for paediatric NICU admission include TBI, status epilepticus, stroke, neuroinfection, and anoxic brain damage following cardiac arrest.[ 9 ] A retrospective cohort analysis of paediatric ICU admission in the USA showed a higher proportion of children having a diagnosis of stroke and status epilepticus with a lower incidence of TBI, neuroinfection and neuroinflammatory disease.[ 10 ] Our NICU has multiple sources of paediatric admissions, namely, the medical, surgical and emergency units and transfers from operating rooms, and our NICU admission pattern resembles that reported in the USA.[ 11 ] The most common indication for NICU admission in our study was the need for post-operative observation after neurosurgery, either for a close watch for neurological worsening, optimisation of haemodynamic management or for delayed recovery or non-extubation after surgery. The indications for NICU admission after paediatric neurosurgery include poor preoperative neurological status, adverse perioperative events, prolonged surgery, or extensive neural tissue handling. The NICU stay permits longer, more frequent, and vigilant monitoring and care of these patients.[ 12 ] About 24% of our patients had neurological complications in the form of either global neurological deterioration with a drop in the GCS score, development of focal neurological deficits or acute events such as pneumocephalus, and seizures. Neuro-pulmonary interactions significantly influence cerebral homeostasis.[ 13 ] Respiratory insufficiency was seen among 19% of children who required NICU admission for airway and ventilatory management. The NICU care allowed closer cardiovascular monitoring and prompt management among 4.44% of those with haemodynamic instability. The complications that occurred during the NICU stay ranged from neurological events of seizures, cerebral oedema, and intracranial hypertension to respiratory events of neurogenic pulmonary oedema and ventilator dependence. This agrees with previous observations by other PNCC units across the globe.[ 14 ] Haemodynamic complications such as hypotension and uncontrolled hypertension were the most common types of complications, while the least common was procedure-related, which was related to central venous cannulation. The lag in anatomical development, functional neurological immaturity, the plasticity of the paediatric brain and the unique pathophysiological challenges in these patients make monitoring and treatment different from adult patients.[ 15 ] A study involving 325 children with varied primary neurological diagnoses observed high rates of death and new disability at discharge among children availing of PNCC services. Children who required multiple CCI and had seizures developed a new disability.[ 16 ] The duration of NICU and hospital stay, mortality, re-admission, and neurological status at discharge are key yardsticks for clinical outcomes.[ 17 ] All these parameters were evaluated in our study. We observed significant differences in the duration of NICU stay and GCS score at NICU and hospital discharge between neurological and neurosurgical patients. There was a 5.56% (5/90 patients) incidence of NICU re-admission in our study cohort, secondary to neurological deterioration (n = 2) and respiratory distress (n = 3). The overall in-hospital mortality rate was 11.11% (10/90 patients), with a slightly increased incidence (6/73) in neurosurgical patients. Earlier studies reported meningitis and septic shock as the most common causes of death in children in the ICUs.[ 18 , 19 ] Patients with a neurological diagnosis stayed 10 days longer in the NICU and 9 days longer in the hospital compared to those with neurosurgical illness. Neurological patients diagnosed with primary neuromuscular disorders experience a longer disease course requiring prolonged ventilator assistance. Similarly, children with GBS requiring NICU care exhibit distinctive characteristics, including a higher prevalence of the AMAN subtype.[ 20 ] This explains the longer (6 versus 3 days) duration of mechanical ventilation in these children. The GCS score at NICU and hospital discharge was significantly better among the neurosurgical patients as most neurology patients were tracheostomised, and the verbal component was given a score of one in such patients. Our re-admission rate of 5.5% is higher than the 2.5% reported by a previous study.[ 21 ] In the reported study, complex chronic conditions were the most common cause of ICU readmission, while acute neurological and respiratory deterioration were the common causes of NICU readmission in our study cohort. Neurological diagnosis has been reported to contribute to nearly 28% of paediatric ICU re-admissions in a multi-specialty ICU setting.[ 22 ] Earlier studies did not compare the CCIs among the NICU patients, which our study has addressed. The CCIs in the NICU are aimed at monitoring and maintaining systemic and intracranial homeostasis, ranging from invasive monitoring of blood pressure, central venous pressure and ICP, to non-invasive continuous monitoring of electroencephalogram for seizures. The therapeutic interventions include institution of mechanical ventilation to improve oxygenation and maintain carbon dioxide levels, tracheostomy to facilitate prolonged ventilation and reduce ICU stay, vasopressor and inotrope administration to support the cardiovascular system, cardiopulmonary resuscitation to restore circulation after cardiac arrest, plasmapheresis for antibody removal in GBS and Myasthenia gravis, surgery to treat intracranial and spinal pathology, and external ventricular drain to monitor and treat raised ICP. The most common CCI performed in our study population was mechanical ventilation. The CCIs were more in the neurological than the neurosurgical population. The number of CCIs significantly affected the clinical outcomes in our study. A recent paediatric study demonstrated that the mortality rates were higher among those who were mechanically ventilated versus those who were not.[ 23 ] In the same study, the requirement for haemodynamic support was associated with higher mortality in the paediatric ICU. In this study, we computed a cumulative CCI score based on the number of monitoring-based, care-based, and therapeutic-based interventions. Our study demonstrates that the number of CCIs was significantly associated with clinical outcomes, with a moderate positive correlation for the duration of ICU, hospital stay, and mechanical ventilation, as well as a negative correlation for the GCS score at hospital discharge and mortality. This is probably the first study to evaluate the burden of paediatric NICU admissions in a developing country, compare outcomes between paediatric neurological and neurosurgical populations and assess the impact of CCIs on patient-important outcomes. However, our study has certain limitations. First, this is a retrospective study, contributing to the bias associated with this study design. Second, being a single-centre study, the generalisation of our findings to a wider population may be limited. Lastly, the small sample and lack of comparison with an adult population in the NICU are other limitations of this study. CONCLUSION To conclude, a significant proportion of NICU admissions are children requiring PNCC services. The NICU management, including CCIs, differs substantially between children with neurological and neurosurgical conditions. The number of CCIs in children during their stay in the NICU correlates significantly with clinical outcomes. More studies are needed, especially from resource-limited countries, to determine if dedicated PNCC services are essential to improve outcomes. Declarations Competing Interests: All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest or non-financial interest in the subject matter or materials discussed in this manuscript. Funding: No funding was received for conducting this study Acknowledgments: Nil Compliance with Ethical Standards Disclosure of potential conflicts of interest: None to declare Research involving Human Participants: Yes Informed consent: Not applicable due to retrospective nature of the study Data, Material and/or Code availability: On request Authors’ contribution statements: The manuscript has been read and approved by all the authors, the requirements for authorship have been met, and each author believes that the manuscript represents honest work. AN, KS and RPS were involved in the conceptualisation of the research work. TGM, SM and SSMR performed medical record retrieval and data collection. KS performed the statistical analysis. RPS wrote the manuscript draft, prepared tables and figures which were reviewed and edited by KS. All authors reviewed the manuscript. References Kurtz P, Fitts V, Sumer Z et al (2011) How does care differ for neurological patients admitted to a neurocritical care unit versus a general ICU? Neurocrit Care 15(3):477–480. 10.1007/s12028-011-9539-2 Suarez JI, Zaidat OO, Suri MF et al (2004) Length of stay and mortality in neurocritically ill patients: impact of a specialized neurocritical care team. Crit Care Med 32(11):2311–2317. 10.1097/01.ccm.0000146132.29042.4c Jeong JH, Bang J, Jeong W et al (2019) A Dedicated Neurological Intensive Care Unit Offers Improved Outcomes for Patients With Brain and Spine Injuries. J Intensive Care Med 34(2):104–108. 10.1177/0885066617706675 Tasker RC (2009) Pediatric neurocritical care: Is it time to come of age? Curr Opin Pediatr 21:724730. 10.1097/MOP.0b013e328331e813 LaRovere KL, Graham RJ, Tasker RC, Pediatric Critical Nervous System Program (pCNSp (2013) Pediatric neurocritical care: a neurology consultation model and implication for education and training. Pediatr Neurol 48(3):206–211. 10.1016/j.pediatrneurol.2012.12.006 Kim S, Oh TK, Song IA, Jeon YT (2024) Trend of Intensive Care Unit Admission in Neurology-Neurosurgery Adult Patients in South Korea: A Nationwide Population-Based Cohort Study. J Korean Neurosurg Soc 67(1):84–93. 10.3340/jkns.2023.0082 Pineda JA, Leonard JR, Mazotas IG, Noetzel M, Limbrick DD, Keller MS, Gill J, Doctor A (2013) Effect of implementation of a paediatric neurocritical care programme on outcomes after severe traumatic brain injury: a retrospective cohort study. Lancet Neurol 12(1):45–52. 10.1016/S1474-4422(12)70269-7 Killien EY, Keller MR, Watson RS, Hartman ME (2023) Epidemiology of Intensive Care Admissions for Children in the US From 2001 to 2019. JAMA Pediatr 177(5):506–515. 10.1001/jamapediatrics.2023.0184 Moreau JF, Fink EL, Hartman ME et al (2013) Hospitalizations of children with neurologic disorders in the United States. Pediatr Crit Care Med 14(8):801–810. 10.1097/PCC.0b013e31828aa71f Heneghan JA, Rogerson C, Goodman DM, Hall M, Kohne JG, Kane JM (2022) Epidemiology of Pediatric Critical Care Admissions in 43 United States Children's Hospitals, 2014–2019. Pediatr Crit Care Med 23(7):484–492. 10.1097/PCC.0000000000002956 Seifu A, Eshetu O, Tafesse D, Hailu S (2022) Admission pattern, treatment outcomes, and associated factors for children admitted to pediatric intensive care unit of Tikur Anbessa specialized hospital, 2021: a retrospective cross-sectional study. BMC Anesthesiol 22(1):13. 10.1186/s12871-021-01556-7 Palaniswamy SR, Kamath S (2021) Recovery and Postoperative Care in Children Undergoing Neurosurgery. In: Rath GP (ed) Fundamentals of Pediatric Neuroanesthesia. Springer, Singapore, pp 613–629 Nguyen TL, Simon DW, Lai YC (2024) Beyond the brain: General intensive care considerations in pediatric neurocritical care. Semin Pediatr Neurol 49:101120. 10.1016/j.spen.2024.101120 Raghu VK, Horvat CM, Kochanek PM et al (2021) Neurological Complications Acquired During Pediatric Critical Illness: Exploratory Mixed Graphical Modeling Analysis Using Serum Biomarker Levels. Pediatr Crit Care Med 22(10):906–914. 10.1097/PCC.0000000000002776 Palaniswamy SR, Srinivas 1 ; Mishra, Rajeeb 1 ; Srinivas Dwarakanath 2 . Anesthetic considerations and care management of children with traumatic brain injury. Journal of Pediatric Neurosciences 17(3):p 185–193, July-September 2022. | 10.4103/jpn.jpn_87_21 Williams CN, Eriksson CO, Kirby A, Piantino JA, Hall TA, Luther M, McEvoy CT (2019) Hospital mortality and functional outcomes in pediatric neurocritical care. Hosp Pediatr 9(12):958–966. 10.1542/hpeds.2019-0173 Heneghan JA, Pollack MM (2017) Morbidity: Changing the Outcome Paradigm for Pediatric Critical Care. Pediatr Clin North Am 64(5):1147–1165. 10.1016/j.pcl.2017.06.011 Au AK, Carcillo JA, Clark RS, Bell MJ (2011) Brain injuries and neurological system failure are the most common proximate causes of death in children admitted to a pediatric intensive care unit. Pediatr Crit Care Med 12(5):566–571. 10.1097/PCC.0b013e3181fe3420 Kilbaugh TJ, Huh JW, Berg RA (2011) Neurological injuries are common contributors to pediatric intensive care unit deaths: a wake-up call. Pediatr Crit Care Med 12(5):601–602. 10.1097/PCC.0b013e3181fe3b2b Surve RM, Sharma P, Nisal R et al (2025) Clinical characteristics and functional outcomes of pediatric Guillain-Barré syndrome admitted to the Neuro-intensive care unit: a decade-long retrospective observational study. Neurol Sci 46(3):1369–1377. 10.1007/s10072-024-07862-5 Sharp EA, Wang L, Hall M, Berry JG, Forster CS (2023) Frequency, Characteristics, and Outcomes of Patients Requiring Early PICU Readmission. Hosp Pediatr 13(8):678–688. 10.1542/hpeds.2022-007100 Edwards JD, Lucas AR, Stone PW, Boscardin WJ, Dudley RA (2013) Frequency, risk factors, and outcomes of early unplanned readmissions to PICUs. Crit Care Med 41(12):2773–2783. 10.1097/CCM.0b013e31829eb970 Dendir G, Awoke N, Alemu A et al (2023) Factors Associated with the Outcome of a Pediatric Patients Admitted to Intensive Care Unit in Resource-Limited Setup: Cross-Sectional Study. Pediatr Health Med Ther 14:71–79. 10.2147/PHMT.S389404 Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Editorial decision: Revision requested 21 Sep, 2025 Reviewers agreed at journal 04 Aug, 2025 Reviews received at journal 08 Jul, 2025 Reviewers agreed at journal 07 Jul, 2025 Reviewers agreed at journal 16 Jun, 2025 Reviewers invited by journal 10 Jun, 2025 Editor assigned by journal 14 Mar, 2025 Submission checks completed at journal 14 Mar, 2025 First submitted to journal 14 Mar, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6225486","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":469447538,"identity":"f552ecd1-6461-4700-a96d-a0812d138fd1","order_by":0,"name":"Amrutha Nirale","email":"","orcid":"","institution":"Trustwell hospital","correspondingAuthor":false,"prefix":"","firstName":"Amrutha","middleName":"","lastName":"Nirale","suffix":""},{"id":469447540,"identity":"48eaf645-e4a1-4e38-8724-5e644bd13766","order_by":1,"name":"Tejaswi GM","email":"","orcid":"","institution":"Aster CMI","correspondingAuthor":false,"prefix":"","firstName":"Tejaswi","middleName":"","lastName":"GM","suffix":""},{"id":469447542,"identity":"7d47d70e-d9cf-4a0e-bd7d-20463fa68c55","order_by":2,"name":"Kamath Sriganesh","email":"","orcid":"","institution":"National Institute of Mental Health and Neurosciences","correspondingAuthor":false,"prefix":"","firstName":"Kamath","middleName":"","lastName":"Sriganesh","suffix":""},{"id":469447543,"identity":"901cabce-ca17-44d4-9f3c-181bd0a1f59a","order_by":3,"name":"Shafaq Malik","email":"","orcid":"","institution":"National Institute of Mental Health and Neurosciences","correspondingAuthor":false,"prefix":"","firstName":"Shafaq","middleName":"","lastName":"Malik","suffix":""},{"id":469447545,"identity":"404684f2-b1c2-4b05-a95e-873bdc86c940","order_by":4,"name":"MR Shubha Shree","email":"","orcid":"","institution":"National Institute of Mental Health and Neurosciences","correspondingAuthor":false,"prefix":"MR","firstName":"Shubha","middleName":"","lastName":"Shree","suffix":""},{"id":469447549,"identity":"f6a889ec-22c6-4daf-b11d-c71a86d5b0b5","order_by":5,"name":"RP Sangeetha","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABBElEQVRIiWNgGAWjYBCDBBBxQKICSDIzNxCjwwCkhfGAxRmQFkbitTAfqGwDcQhokW8/e/jFh4o/efyzzx44cHNebTR/O1DLj4ptuI0/k5dmOeOMQbHEubyEgzO3Hc+dcZixgbHnzG3cWhhyzIx52wwSG87wGByW3HYstwGohZmxDbcW+f43ZsZ//xkkzgdp+TvnWO58QloYbuQYP2ZsMEjcANRyQLKhJncDIS0GN96YMfYcM07ceIYv4YDEsQO5G4FaDuLzi3x/jvGHHzVyifPO8B7+IFFTlzvv/OGDD35U4HEYAwObBITmARGHwcwD+NQDAfMHJC11BBSPglEwCkbBSAQABJRkqFphEI4AAAAASUVORK5CYII=","orcid":"","institution":"National Institute of Mental Health and Neurosciences","correspondingAuthor":true,"prefix":"","firstName":"RP","middleName":"","lastName":"Sangeetha","suffix":""}],"badges":[],"createdAt":"2025-03-14 10:53:26","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6225486/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6225486/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":84531829,"identity":"c571691b-fe2f-4db6-92f6-d0325fececeb","added_by":"auto","created_at":"2025-06-13 06:19:31","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":183157,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eBroad indications for Neuro Intensive Care Unit admission\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-6225486/v1/5da19eb0d97a9e1029828158.jpeg"},{"id":84531466,"identity":"69e5ac74-055e-4d59-942b-1dfb50ed3465","added_by":"auto","created_at":"2025-06-13 06:11:31","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":7311,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eCommon complications during the Neuro Intensive Care Unit stay\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e*Few patients had more than one complication, and hence cumulative numbers are more than the number of patients\u003c/p\u003e","description":"","filename":"Onlinedrawingimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-6225486/v1/41d865ea99052cfa86b47952.png"},{"id":84531470,"identity":"c8053982-b041-40bf-a21e-e5f83ec71bea","added_by":"auto","created_at":"2025-06-13 06:11:31","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":15313,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eDetails of Critical Care Interventions in the Neuro Intensive Care Unit\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"Onlinedrawingimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-6225486/v1/40067776d78d34c1b439d72a.png"},{"id":84533195,"identity":"f94b190b-8275-4b11-9848-2f47b6e369e2","added_by":"auto","created_at":"2025-06-13 06:35:36","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":957891,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6225486/v1/03ee9aa3-3548-46f2-af40-e5eeae8ac9e3.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Clinical Characteristics, Critical Care Interventions and Outcomes of Paediatric Neuro-Intensive Care Unit Admissions - A Retrospective Cohort Study","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eCritically ill neurological patients requiring intensive care unit (ICU) admission are usually cared for in the neuro-intensive care unit (NICU). The care of these neurosurgical and neurological patients in the NICU differs from the general ICU.[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e] The clinical outcomes, including mortality, are better in dedicated NICUs with trained neurointensivists than in the general ICUs.[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e] Children with neurological illnesses requiring ICU care are managed alongside adults in NICUs or in paediatric ICUs in many hospitals. It is increasingly felt that children with neurological illnesses requiring NICU care may be served better with a dedicated pediatric neuro-critical care (PNCC) setup, considering the unique concerns of children.[\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e] While dedicated PNCC services exist in the United States of America (USA),[\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e] such facilities are lacking in the developing world, including India, which cater to a large paediatric population requiring neurocritical care. However, initiating PNCC services requires additional resources for reorganisation, as well as multi-disciplinary expertise involving paediatrics, paediatric neurology, paediatric neurosurgery, and neurocritical care. Therefore, before embarking on a change in practice, there is a need for robust data on paediatric NICU admissions, management practices and clinical outcomes in the existing scenario.\u003c/p\u003e \u003cp\u003eAdult patients admitted to the NICU with neurosurgical and neurological diagnoses differ not only with regard to their clinical conditions but also with respect to outcomes.[\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e] Though there are no similar studies in children, it is likely that there may be differences in critical care interventions (CCI) and clinical outcomes in children with neurosurgical and neurological diagnoses. Therefore, it is necessary to understand the burden of paediatric NICU admissions in relation to the total NICU admissions and also evaluate CCI and outcomes among paediatric neurosurgical and neurological diagnoses.\u003c/p\u003e \u003cp\u003eThe primary objective of this study was to assess the incidence of paediatric NICU admissions in our NICU over a one-year period. Our secondary objectives were to assess indications for NICU admission, incidence and indications for re-admission to the NICU, NICU complications, the number and types of CCIs performed during the NICU stay and compare clinical characteristics and outcomes between children with neurosurgical and neurological diagnoses. We also aimed to assess the correlation between CCI in the NICU and patient-important outcomes in children with critical neurological and neurosurgical disorders.\u003c/p\u003e"},{"header":"METHODS","content":"\u003cp\u003eThis retrospective observational study was conducted after institute ethics committee approval (No. NIMHANS/IEC/2023 dated 05.12.2023) and involved children aged\u0026thinsp;\u0026lt;\u0026thinsp;18 years admitted to the NICU of a tertiary care academic neurosciences hospital between January to December 2023. The following data were collected from the patient healthcare records \u0026ndash; name and hospital identification number (de-anonymised at analysis), age, gender, neurological and neurosurgical diagnosis, date of admission and discharge from the hospital, indication for NICU admission, type of surgery where relevant, date of NICU admission and discharge (NICU duration), presence of tracheal tube at NICU admission and discharge, indication for NICU admission (postoperative observation/monitoring, poor neurological status or neurological decline, respiratory insufficiency requiring intubation with or without mechanical ventilation, and cardiovascular compromise requiring haemodynamic support), Glasgow Coma Scale (GCS) score at NICU and hospital admission, and NICU complications. We collected the incidence and details of the following CCIs in the NICU - mechanical ventilation, central venous cannulation, arterial cannulation, intracranial pressure [ICP] monitoring, external ventricular drain placement, plasmapheresis, electroencephalogram monitoring, haemodynamic support administration, cardiopulmonary resuscitation, tracheostomy, and surgery/intervention. The data regarding the following outcomes were collected \u0026ndash; duration of mechanical ventilation, duration of NICU and hospital stay, GCS score at NICU and hospital discharge, NICU readmission and in-hospital mortality. The intubated or tracheostomised patients were scored as 1 for verbal response in the GCS score assessment.\u003c/p\u003e \u003cp\u003eNo formal sample size calculation was performed for this exploratory study. The study data was analysed using the SPSS software, version 23. Interval and ordinal scale data are described using means and standard deviations or as medians and interquartile ranges, while categorical data are expressed as frequencies and percentages. Non-parametric Mann-Whitney U test was used to compare differences between neurosurgical and neurological patients for parameters that were ordinal or continuous but not normally distributed. The chi-square test was used to compare differences between the neurosurgical and neurological populations for categorical variables. We used Spearman\u0026rsquo;s correlation test to measure the strength and direction of the relationship between CCIs and patient outcomes. A p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered statistically significant.\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cp\u003eA total of 1,153 patients were admitted to the NICU during the study period from January to December 2023. Of these, 90 admissions were children accounting for 7.8% of the total NICU admissions. The demographic and baseline clinical characteristics are depicted in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. The median age of our overall study population was 12 years (4.5\u0026ndash;14.5). There were more male children in the overall study sample and also in the neurosurgery group, while females were more in the neurology population.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eDemographic and baseline clinical characteristics of the study population. Values are expressed as median and interquartile range for quantitative variables and number and percentage for qualitative variables.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eParameters\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eOverall\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;90)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNeurosurgery (n\u0026thinsp;=\u0026thinsp;73)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eNeurology (n\u0026thinsp;=\u0026thinsp;17)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eAge (years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12 (4.5\u0026ndash;14.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e12 (1\u0026ndash;14)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e15 (11.5\u0026ndash;16)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eMale gender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e50 (55.56%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e43 (58.9%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e7 (41.18%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\" morerows=\"7\" rowspan=\"8\"\u003e \u003cp\u003eDiagnosis\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNeoplastic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\" morerows=\"7\" rowspan=\"8\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e41 (56.16%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\" morerows=\"4\" rowspan=\"5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCongenital\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15 (20.55%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eVascular\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e7 (9.59%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eInfective\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6 (8.22%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTraumatic\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4 (5.48%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNeuro-Muscular Disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e9 (52.94%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSeizures\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4 (23.53%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eInfective\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4 (23.53%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eGCS score at hospital admission\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15 (14\u0026ndash;15)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e15 (14\u0026ndash;15)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e14 (11\u0026ndash;15)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eGCS score at NICU admission\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10 (7\u0026ndash;11)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10 (7\u0026ndash;11)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e10 (6\u0026ndash;11)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eIntubated at the ICU admission\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e71 (78.89%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e58 (79.45%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e13 (76.47%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eGCS - Glasgow Coma Scale; NICU \u0026ndash; Neuro Intensive Care Unit\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eIn our study, most children admitted to the NICU belonged to the neurosurgical speciality (73/90, 81.11%), with the rest having neurological diagnoses (17/90, 18.88%). Among the neurosurgical population, the most common diagnosis was cranial and spinal neoplastic lesions (56.16%), followed by congenital disorders (20.55%) such as atlantoaxial dislocation, craniosynostosis, hydrocephalus, and meningomyelocele. The less common neurosurgical diagnoses were vascular pathologies (9.59%) such as arterio-venous malformations and cerebral venous thrombosis, and brain infections (8.22%), such as cranial abscess, subdural empyema and postoperative ventriculitis, with least common being traumatic brain injury (TBI) (5.48%). Among the neurological diagnoses, the most common pathology was related to the peripheral nervous system (52.94%) and included Guillain-Barre syndrome (GBS), lower motor neuron syndrome, and hemiballismus. The less common neurological pathologies were neuroinfections (23.53%) and seizure disorders (23.53%). The median GCS score of our study population at the hospital and NICU admission were 15 and 10, respectively. Most children (71/90, 79%) were admitted to the NICU with their trachea already intubated.\u003c/p\u003e \u003cp\u003eThe indications for NICU admission were broadly categorised based on the system involved and postoperative aetiology and is depicted in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. The indications were post-operative observation in 47/90 (52.22%) children, focal or global neurological deterioration in 22/90 (24.44%), respiratory insufficiency in 17/90 (18.89%), and cardiovascular and haemodynamic compromise in 4/90 (4.44%) paediatric patients.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eSixty-nine (76.67%) children did not develop complications during their stay in the NICU. The remaining children developed various complications, with some more than one complication, and these are depicted in Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. There were 16 adverse haemodynamic events, seven respiratory complications, five new-onset neurological events, such as seizures and focal deficit, and one complication related to a procedure performed in the NICU.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e During their NICU stay, children underwent many CCIs as part of their NICU care. The most common CCI was mechanical ventilation, and the least common was invasive ICP monitoring. The details of all the CCIs are depicted in Fig.\u0026nbsp;\u003cspan refid=\"Fig3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eThe comparison between children with neurosurgical and neurological diagnoses for various clinical outcomes is depicted in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. The number of CCIs (p\u0026thinsp;=\u0026thinsp;0.004), duration of ICU stay (p\u0026thinsp;=\u0026thinsp;0.018), GCS score at NICU discharge (p\u0026thinsp;=\u0026thinsp;0.005) and GCS score at hospital discharge (p\u0026thinsp;=\u0026thinsp;0.011) were significantly different between neurosurgical and neurological populations. The children with neurological diagnoses underwent more CCIs, had a longer NICU stay, and had a lower GCS score at NICU and hospital discharge compared to children with neurosurgical diagnoses. The NICU readmission rates and in-hospital mortality were, however, not statistically significant.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eClinically important patient outcomes in children admitted to the Neuro Intensive Care Unit. Variables are expressed as median and interquartile range or as number and percentage.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOutcomes\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eOverall\u003c/p\u003e \u003cp\u003e(n\u0026thinsp;=\u0026thinsp;90)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eNeurosurgery (n\u0026thinsp;=\u0026thinsp;73)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNeurology (n\u0026thinsp;=\u0026thinsp;17)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNumber of CCIs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2 (0\u0026ndash;4)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1 (0\u0026ndash;3)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e5 (3\u0026ndash;9)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.004\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDuration of NICU stay (days)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4 (2\u0026ndash;11)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4 (2\u0026ndash;6.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e14 (3.5\u0026ndash;23.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.018\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDuration of hospital stay (days)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18.5 (12\u0026ndash;28.75)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17 (11.5\u0026ndash;27.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e26 (16\u0026ndash;63.5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.106\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDuration of ventilation (days)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3 (1\u0026ndash;6)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3 (1\u0026ndash;5)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e6 (2\u0026ndash;19)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.068\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGCS score at NICU discharge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15 (11\u0026ndash;15)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15 (12\u0026ndash;15)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e11 (8\u0026ndash;15)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.005\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGCS score at hospital discharge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e15 (15\u0026ndash;15)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15 (15\u0026ndash;15)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e13 (11\u0026ndash;15)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e0.011\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNICU re-admission\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5/90 (5.56%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3/73 (4.11%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2/17 (11.77%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.237\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIn-hospital mortality\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10/90 (11.11%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6/73 (8.22%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e4/17 (23.53%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.090\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"5\"\u003eCCI - Critical Care Intervention; GCS - Glasgow Coma Scale; NICU \u0026ndash; Neuro Intensive Care Unit\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe influence of CCIs on patient outcomes is depicted in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e. The CCIs significantly influenced the patient outcomes (P\u0026thinsp;\u0026lt;\u0026thinsp;0.001). The frequency of CCIs had a moderate positive correlation with outcomes such as the duration of hospital and NICU stay and duration of mechanical ventilation. On the other hand, outcomes such as GCS score at NICU and hospital discharge had a moderate negative correlation with the number of CCIs.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCorrelation between the cumulative Critical Care Interventions score and patient outcomes in children admitted to the Neuro Intensive Care Unit.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCCI\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDuration of NICU stay\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDuration of hospital stay\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eDuration of mechanical ventilation\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eGCS score at NICU discharge\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eGCS score at hospital discharge\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCorrelation coefficient\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.606\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.378\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.533\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.449\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0.502\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eP value\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"6\"\u003eCCI - Critical Care Interventions; GCS - Glasgow Coma Scale; NICU - Neuro Intensive Care Unit\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThis study evaluated the burden of paediatric NICU admissions in a neurosciences tertiary care academic hospital from India, compared the outcomes among paediatric neurosurgical and neurological populations and investigated the correlation between CCIs in NICU and clinical outcomes in children with neurological and neurosurgical disorders. In our study, about 8% of the NICU admissions were children requiring PNCC services. Significant differences were noted between neurosurgical and neurological diagnoses in the children admitted to the NICU for the number of CCIs during the NICU stay, duration of NICU stay, and GCS score at NICU and hospital discharge. The number of CCIs correlated significantly and positively with the duration of mechanical ventilation, NICU stay and hospital stay, and significantly and negatively with the GCS score at NICU and hospital discharge.\u003c/p\u003e \u003cp\u003eAn earlier study demonstrated that dedicated PNCC units have reduced mortality after paediatric TBI.[\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e] This underscores the role of a dedicated monitoring and care system for this vulnerable population of children with acute neurological illness. However, studies evaluating the impact of paediatric NICU admissions are lacking. The existing literature compares outcomes among adult neurological patients managed in the general ICU versus the NICU. These studies documented better outcomes with dedicated NICU admissions.[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e] For children, the literature predominantly focuses on ICU requirements as a proportion of all paediatric hospital admissions.[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e] In contrast, our study determined the burden of children requiring NICU admission as a proportion of total NICU admissions. The proportion of paediatric NICU admissions is significant to consider curated care pathways for age-specific specialised monitoring and equipment, skilled and trained personnel, and interdisciplinary care systems appropriate for children with acute neurological disorders for better decision-making and holistic patient management to improve outcomes.\u003c/p\u003e \u003cp\u003eThe indications of paediatric admissions to the NICU may differ from those of their adult counterparts. The common indications for paediatric NICU admission include TBI, status epilepticus, stroke, neuroinfection, and anoxic brain damage following cardiac arrest.[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e] A retrospective cohort analysis of paediatric ICU admission in the USA showed a higher proportion of children having a diagnosis of stroke and status epilepticus with a lower incidence of TBI, neuroinfection and neuroinflammatory disease.[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e] Our NICU has multiple sources of paediatric admissions, namely, the medical, surgical and emergency units and transfers from operating rooms, and our NICU admission pattern resembles that reported in the USA.[\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eThe most common indication for NICU admission in our study was the need for post-operative observation after neurosurgery, either for a close watch for neurological worsening, optimisation of haemodynamic management or for delayed recovery or non-extubation after surgery. The indications for NICU admission after paediatric neurosurgery include poor preoperative neurological status, adverse perioperative events, prolonged surgery, or extensive neural tissue handling. The NICU stay permits longer, more frequent, and vigilant monitoring and care of these patients.[\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e] About 24% of our patients had neurological complications in the form of either global neurological deterioration with a drop in the GCS score, development of focal neurological deficits or acute events such as pneumocephalus, and seizures. Neuro-pulmonary interactions significantly influence cerebral homeostasis.[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e] Respiratory insufficiency was seen among 19% of children who required NICU admission for airway and ventilatory management. The NICU care allowed closer cardiovascular monitoring and prompt management among 4.44% of those with haemodynamic instability.\u003c/p\u003e \u003cp\u003eThe complications that occurred during the NICU stay ranged from neurological events of seizures, cerebral oedema, and intracranial hypertension to respiratory events of neurogenic pulmonary oedema and ventilator dependence. This agrees with previous observations by other PNCC units across the globe.[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e] Haemodynamic complications such as hypotension and uncontrolled hypertension were the most common types of complications, while the least common was procedure-related, which was related to central venous cannulation.\u003c/p\u003e \u003cp\u003eThe lag in anatomical development, functional neurological immaturity, the plasticity of the paediatric brain and the unique pathophysiological challenges in these patients make monitoring and treatment different from adult patients.[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eA study involving 325 children with varied primary neurological diagnoses observed high rates of death and new disability at discharge among children availing of PNCC services. Children who required multiple CCI and had seizures developed a new disability.[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eThe duration of NICU and hospital stay, mortality, re-admission, and neurological status at discharge are key yardsticks for clinical outcomes.[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e] All these parameters were evaluated in our study. We observed significant differences in the duration of NICU stay and GCS score at NICU and hospital discharge between neurological and neurosurgical patients.\u003c/p\u003e \u003cp\u003eThere was a 5.56% (5/90 patients) incidence of NICU re-admission in our study cohort, secondary to neurological deterioration (n\u0026thinsp;=\u0026thinsp;2) and respiratory distress (n\u0026thinsp;=\u0026thinsp;3). The overall in-hospital mortality rate was 11.11% (10/90 patients), with a slightly increased incidence (6/73) in neurosurgical patients. Earlier studies reported meningitis and septic shock as the most common causes of death in children in the ICUs.[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]\u003c/p\u003e \u003cp\u003ePatients with a neurological diagnosis stayed 10 days longer in the NICU and 9 days longer in the hospital compared to those with neurosurgical illness. Neurological patients diagnosed with primary neuromuscular disorders experience a longer disease course requiring prolonged ventilator assistance. Similarly, children with GBS requiring NICU care exhibit distinctive characteristics, including a higher prevalence of the AMAN subtype.[\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e] This explains the longer (6 versus 3 days) duration of mechanical ventilation in these children.\u003c/p\u003e \u003cp\u003eThe GCS score at NICU and hospital discharge was significantly better among the neurosurgical patients as most neurology patients were tracheostomised, and the verbal component was given a score of one in such patients.\u003c/p\u003e \u003cp\u003eOur re-admission rate of 5.5% is higher than the 2.5% reported by a previous study.[\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e] In the reported study, complex chronic conditions were the most common cause of ICU readmission, while acute neurological and respiratory deterioration were the common causes of NICU readmission in our study cohort. Neurological diagnosis has been reported to contribute to nearly 28% of paediatric ICU re-admissions in a multi-specialty ICU setting.[\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]\u003c/p\u003e \u003cp\u003eEarlier studies did not compare the CCIs among the NICU patients, which our study has addressed. The CCIs in the NICU are aimed at monitoring and maintaining systemic and intracranial homeostasis, ranging from invasive monitoring of blood pressure, central venous pressure and ICP, to non-invasive continuous monitoring of electroencephalogram for seizures. The therapeutic interventions include institution of mechanical ventilation to improve oxygenation and maintain carbon dioxide levels, tracheostomy to facilitate prolonged ventilation and reduce ICU stay, vasopressor and inotrope administration to support the cardiovascular system, cardiopulmonary resuscitation to restore circulation after cardiac arrest, plasmapheresis for antibody removal in GBS and Myasthenia gravis, surgery to treat intracranial and spinal pathology, and external ventricular drain to monitor and treat raised ICP. The most common CCI performed in our study population was mechanical ventilation. The CCIs were more in the neurological than the neurosurgical population. The number of CCIs significantly affected the clinical outcomes in our study. A recent paediatric study demonstrated that the mortality rates were higher among those who were mechanically ventilated versus those who were not.[\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e] In the same study, the requirement for haemodynamic support was associated with higher mortality in the paediatric ICU.\u003c/p\u003e \u003cp\u003eIn this study, we computed a cumulative CCI score based on the number of monitoring-based, care-based, and therapeutic-based interventions. Our study demonstrates that the number of CCIs was significantly associated with clinical outcomes, with a moderate positive correlation for the duration of ICU, hospital stay, and mechanical ventilation, as well as a negative correlation for the GCS score at hospital discharge and mortality.\u003c/p\u003e \u003cp\u003eThis is probably the first study to evaluate the burden of paediatric NICU admissions in a developing country, compare outcomes between paediatric neurological and neurosurgical populations and assess the impact of CCIs on patient-important outcomes. However, our study has certain limitations. First, this is a retrospective study, contributing to the bias associated with this study design. Second, being a single-centre study, the generalisation of our findings to a wider population may be limited. Lastly, the small sample and lack of comparison with an adult population in the NICU are other limitations of this study.\u003c/p\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eTo conclude, a significant proportion of NICU admissions are children requiring PNCC services. The NICU management, including CCIs, differs substantially between children with neurological and neurosurgical conditions. The number of CCIs in children during their stay in the NICU correlates significantly with clinical outcomes. More studies are needed, especially from resource-limited countries, to determine if dedicated PNCC services are essential to improve outcomes.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eCompeting Interests:\u003c/strong\u003e All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest or non-financial interest in the subject matter or materials discussed in this manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding:\u0026nbsp;\u003c/strong\u003eNo funding was received for conducting this study\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments:\u0026nbsp;\u003c/strong\u003eNil\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompliance with Ethical Standards\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDisclosure of potential conflicts of interest:\u0026nbsp;\u003c/strong\u003eNone to declare\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResearch involving Human Participants:\u0026nbsp;\u003c/strong\u003eYes\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInformed consent:\u0026nbsp;\u003c/strong\u003eNot applicable due to retrospective nature of the study\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData, Material and/or Code availability:\u0026nbsp;\u003c/strong\u003eOn request\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contribution statements:\u0026nbsp;\u003c/strong\u003eThe manuscript has been read and approved by all the authors, the requirements for authorship have been met, and each author believes that the manuscript represents honest work.\u003c/p\u003e\n\u003cp\u003eAN, KS and RPS were involved in the conceptualisation of the research work. TGM, SM and SSMR performed medical record retrieval and data collection. KS performed the statistical analysis. RPS wrote the manuscript draft, prepared tables and figures which were reviewed and edited by KS. All authors reviewed the manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eKurtz P, Fitts V, Sumer Z et al (2011) How does care differ for neurological patients admitted to a neurocritical care unit versus a general ICU? Neurocrit Care 15(3):477\u0026ndash;480. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s12028-011-9539-2\u003c/span\u003e\u003cspan address=\"10.1007/s12028-011-9539-2\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSuarez JI, Zaidat OO, Suri MF et al (2004) Length of stay and mortality in neurocritically ill patients: impact of a specialized neurocritical care team. Crit Care Med 32(11):2311\u0026ndash;2317. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1097/01.ccm.0000146132.29042.4c\u003c/span\u003e\u003cspan address=\"10.1097/01.ccm.0000146132.29042.4c\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJeong JH, Bang J, Jeong W et al (2019) A Dedicated Neurological Intensive Care Unit Offers Improved Outcomes for Patients With Brain and Spine Injuries. J Intensive Care Med 34(2):104\u0026ndash;108. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1177/0885066617706675\u003c/span\u003e\u003cspan address=\"10.1177/0885066617706675\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eTasker RC (2009) Pediatric neurocritical care: Is it time to come of age? Curr Opin Pediatr 21:724730. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1097/MOP.0b013e328331e813\u003c/span\u003e\u003cspan address=\"10.1097/MOP.0b013e328331e813\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLaRovere KL, Graham RJ, Tasker RC, Pediatric Critical Nervous System Program (pCNSp (2013) Pediatric neurocritical care: a neurology consultation model and implication for education and training. Pediatr Neurol 48(3):206\u0026ndash;211. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.pediatrneurol.2012.12.006\u003c/span\u003e\u003cspan address=\"10.1016/j.pediatrneurol.2012.12.006\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKim S, Oh TK, Song IA, Jeon YT (2024) Trend of Intensive Care Unit Admission in Neurology-Neurosurgery Adult Patients in South Korea: A Nationwide Population-Based Cohort Study. J Korean Neurosurg Soc 67(1):84\u0026ndash;93. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3340/jkns.2023.0082\u003c/span\u003e\u003cspan address=\"10.3340/jkns.2023.0082\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePineda JA, Leonard JR, Mazotas IG, Noetzel M, Limbrick DD, Keller MS, Gill J, Doctor A (2013) Effect of implementation of a paediatric neurocritical care programme on outcomes after severe traumatic brain injury: a retrospective cohort study. Lancet Neurol 12(1):45\u0026ndash;52. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/S1474-4422(12)70269-7\u003c/span\u003e\u003cspan address=\"10.1016/S1474-4422(12)70269-7\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKillien EY, Keller MR, Watson RS, Hartman ME (2023) Epidemiology of Intensive Care Admissions for Children in the US From 2001 to 2019. JAMA Pediatr 177(5):506\u0026ndash;515. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1001/jamapediatrics.2023.0184\u003c/span\u003e\u003cspan address=\"10.1001/jamapediatrics.2023.0184\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMoreau JF, Fink EL, Hartman ME et al (2013) Hospitalizations of children with neurologic disorders in the United States. Pediatr Crit Care Med 14(8):801\u0026ndash;810. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1097/PCC.0b013e31828aa71f\u003c/span\u003e\u003cspan address=\"10.1097/PCC.0b013e31828aa71f\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHeneghan JA, Rogerson C, Goodman DM, Hall M, Kohne JG, Kane JM (2022) Epidemiology of Pediatric Critical Care Admissions in 43 United States Children's Hospitals, 2014\u0026ndash;2019. Pediatr Crit Care Med 23(7):484\u0026ndash;492. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1097/PCC.0000000000002956\u003c/span\u003e\u003cspan address=\"10.1097/PCC.0000000000002956\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSeifu A, Eshetu O, Tafesse D, Hailu S (2022) Admission pattern, treatment outcomes, and associated factors for children admitted to pediatric intensive care unit of Tikur Anbessa specialized hospital, 2021: a retrospective cross-sectional study. BMC Anesthesiol 22(1):13. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s12871-021-01556-7\u003c/span\u003e\u003cspan address=\"10.1186/s12871-021-01556-7\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePalaniswamy SR, Kamath S (2021) Recovery and Postoperative Care in Children Undergoing Neurosurgery. In: Rath GP (ed) Fundamentals of Pediatric Neuroanesthesia. Springer, Singapore, pp 613\u0026ndash;629\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNguyen TL, Simon DW, Lai YC (2024) Beyond the brain: General intensive care considerations in pediatric neurocritical care. Semin Pediatr Neurol 49:101120. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.spen.2024.101120\u003c/span\u003e\u003cspan address=\"10.1016/j.spen.2024.101120\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRaghu VK, Horvat CM, Kochanek PM et al (2021) Neurological Complications Acquired During Pediatric Critical Illness: Exploratory Mixed Graphical Modeling Analysis Using Serum Biomarker Levels. Pediatr Crit Care Med 22(10):906\u0026ndash;914. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1097/PCC.0000000000002776\u003c/span\u003e\u003cspan address=\"10.1097/PCC.0000000000002776\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePalaniswamy SR, Srinivas \u003csup\u003e1\u003c/sup\u003e; Mishra, Rajeeb\u003csup\u003e1\u003c/sup\u003e; Srinivas Dwarakanath\u003csup\u003e2\u003c/sup\u003e. Anesthetic considerations and care management of children with traumatic brain injury. Journal of Pediatric Neurosciences 17(3):p 185\u0026ndash;193, July-September 2022. | \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.4103/jpn.jpn_87_21\u003c/span\u003e\u003cspan address=\"10.4103/jpn.jpn_87_21\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWilliams CN, Eriksson CO, Kirby A, Piantino JA, Hall TA, Luther M, McEvoy CT (2019) Hospital mortality and functional outcomes in pediatric neurocritical care. Hosp Pediatr 9(12):958\u0026ndash;966. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1542/hpeds.2019-0173\u003c/span\u003e\u003cspan address=\"10.1542/hpeds.2019-0173\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHeneghan JA, Pollack MM (2017) Morbidity: Changing the Outcome Paradigm for Pediatric Critical Care. Pediatr Clin North Am 64(5):1147\u0026ndash;1165. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.pcl.2017.06.011\u003c/span\u003e\u003cspan address=\"10.1016/j.pcl.2017.06.011\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAu AK, Carcillo JA, Clark RS, Bell MJ (2011) Brain injuries and neurological system failure are the most common proximate causes of death in children admitted to a pediatric intensive care unit. Pediatr Crit Care Med 12(5):566\u0026ndash;571. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1097/PCC.0b013e3181fe3420\u003c/span\u003e\u003cspan address=\"10.1097/PCC.0b013e3181fe3420\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKilbaugh TJ, Huh JW, Berg RA (2011) Neurological injuries are common contributors to pediatric intensive care unit deaths: a wake-up call. Pediatr Crit Care Med 12(5):601\u0026ndash;602. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1097/PCC.0b013e3181fe3b2b\u003c/span\u003e\u003cspan address=\"10.1097/PCC.0b013e3181fe3b2b\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSurve RM, Sharma P, Nisal R et al (2025) Clinical characteristics and functional outcomes of pediatric Guillain-Barr\u0026eacute; syndrome admitted to the Neuro-intensive care unit: a decade-long retrospective observational study. Neurol Sci 46(3):1369\u0026ndash;1377. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s10072-024-07862-5\u003c/span\u003e\u003cspan address=\"10.1007/s10072-024-07862-5\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSharp EA, Wang L, Hall M, Berry JG, Forster CS (2023) Frequency, Characteristics, and Outcomes of Patients Requiring Early PICU Readmission. Hosp Pediatr 13(8):678\u0026ndash;688. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1542/hpeds.2022-007100\u003c/span\u003e\u003cspan address=\"10.1542/hpeds.2022-007100\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEdwards JD, Lucas AR, Stone PW, Boscardin WJ, Dudley RA (2013) Frequency, risk factors, and outcomes of early unplanned readmissions to PICUs. Crit Care Med 41(12):2773\u0026ndash;2783. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1097/CCM.0b013e31829eb970\u003c/span\u003e\u003cspan address=\"10.1097/CCM.0b013e31829eb970\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDendir G, Awoke N, Alemu A et al (2023) Factors Associated with the Outcome of a Pediatric Patients Admitted to Intensive Care Unit in Resource-Limited Setup: Cross-Sectional Study. Pediatr Health Med Ther 14:71\u0026ndash;79. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.2147/PHMT.S389404\u003c/span\u003e\u003cspan address=\"10.2147/PHMT.S389404\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"childs-nervous-system","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"cnsy","sideBox":"Learn more about [Child's Nervous System](http://link.springer.com/journal/381)","snPcode":"381","submissionUrl":"https://submission.nature.com/new-submission/381/3","title":"Child's Nervous System","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false},"keywords":"Paediatric neuro-intensive care unit, Paediatric neurology, Paediatric neurosurgery, critical care interventions, outcomes","lastPublishedDoi":"10.21203/rs.3.rs-6225486/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6225486/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003ePurpose\u003c/h2\u003e \u003cp\u003eThere is limited literature regarding the burden, management and outcomes of children managed in the neuro-intensive care unit (NICU). Increasing paediatric NICU admissions presents a huge challenge in developing countries like India. The critical care interventions (CCIs) and clinical outcomes of children with neurological and neurosurgical pathologies may vary but are currently unknown. This study aimed to assess the incidence of paediatric NICU admission and compare the clinical characteristics, NICU management and clinical outcomes between paediatric neurological and neurosurgical populations in the NICU.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eThis retrospective observational study was conducted after institute ethics committee approval and involved children aged\u0026thinsp;\u0026lt;\u0026thinsp;18 years admitted to the NICU of a tertiary care academic neurosciences hospital between January to December 2023.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eAbout 8% (90/1153) of NICU admissions were children. We observed significant differences in the number of CCIs during the NICU stay, duration of NICU stay, and the GCS score at NICU and hospital discharge between paediatric neurological and neurosurgical disorders. The frequency of CCIs correlated significantly with the duration of mechanical ventilation, NICU stay and hospital stay, and GCS score at NICU and hospital discharge.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eOur study suggests that CCIs and clinical outcomes are different for paediatric neurological and neurosurgical patients, and the number of CCIs has a significant impact on clinical outcomes in children admitted to the NICU. Future studies should evaluate if a dedicated paediatric NICU influences outcomes in children with acute and severe neurological diseases.\u003c/p\u003e","manuscriptTitle":"Clinical Characteristics, Critical Care Interventions and Outcomes of Paediatric Neuro-Intensive Care Unit Admissions - A Retrospective Cohort Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-06-13 06:11:26","doi":"10.21203/rs.3.rs-6225486/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2025-09-21T07:38:50+00:00","index":"","fulltext":""},{"type":"reviewerAgreed","content":"325895986518386658648099273537112716245","date":"2025-08-04T06:49:44+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2025-07-08T20:13:43+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"142702311819835395018089929593234230224","date":"2025-07-07T23:18:41+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"209855298385167370786404304378362940988","date":"2025-06-16T04:00:52+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2025-06-10T20:06:57+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-03-14T13:46:23+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-03-14T13:44:34+00:00","index":"","fulltext":""},{"type":"submitted","content":"Child's Nervous System","date":"2025-03-14T10:47:58+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"childs-nervous-system","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"cnsy","sideBox":"Learn more about [Child's Nervous System](http://link.springer.com/journal/381)","snPcode":"381","submissionUrl":"https://submission.nature.com/new-submission/381/3","title":"Child's Nervous System","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"Springer Hybrid","inReviewEnabled":true,"inReviewRevisionsEnabled":false}}],"origin":"","ownerIdentity":"e009cc4e-2eb1-40d3-a8ec-ae12aef21bfb","owner":[],"postedDate":"June 13th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2025-10-14T21:23:11+00:00","versionOfRecord":[],"versionCreatedAt":"2025-06-13 06:11:26","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6225486","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6225486","identity":"rs-6225486","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}