Pediatric Neurocritical Care: Diagnosis, Neuromonitoring and Outcomes

A special issue of Children (ISSN 2227-9067). This special issue belongs to the section "Pediatric Neurology & Neurodevelopmental Disorders".

Deadline for manuscript submissions: closed (25 February 2026) | Viewed by 845

Special Issue Editors


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Guest Editor
Section Neurology, Department of Pediatrics, Cumming School of Medicine, Alberta Children’s Hospital, University of Calgary, 28 Oki Drive NW, Calgary, AB T3B 6A8, Canada
Interests: neuro-critical monitoring; EEG; pediatric neurodevelopment

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Guest Editor
1. Hotchkiss Brain Institute (HBI), University of Calgary, Calgary, AB, Canada
2. Alberta Children's Hospital Research Institute (ACHRI), University of Calgary, Calgary, AB, Canada
3. Department of Pediatrics, Section of Neurology, University of Calgary, Calgary, AB, Canada
Interests: pediatric brain injury; neurocritical care; translational biology; determinants of health; health outcomes; knowledge translation; novel therapeutics

Special Issue Information

Dear Colleagues, 

Over the past two decades, pediatric neurocritical care has emerged as a distinct, multidisciplinary field focused on improving survival and neurodevelopment in critically ill children with acute brain injury. Advances in neuroimaging, electrophysiology, and multimodal neuromonitoring have transformed bedside diagnosis and informed targeted interventions, yet major challenges remain in translating physiologic data into outcome-changing therapies.

Currently, cutting-edge research is focused on integrating continuous multimodal data streams—EEG, cerebral oxygenation, intracranial pressure, and advanced neuroimaging—into predictive models for individualized care. Biomarker discovery, automated seizure detection, and AI-driven analytics are expanding our ability to detect injury earlier, guide interventions in real time, and forecast recovery trajectories. Parallel work is refining neuroprotective strategies, optimizing sedation and seizure management, and expanding outcome measures beyond survival to capture functional and quality-of-life endpoints.

This Special Issue seeks original research, clinical trials, translational studies, and high-quality reviews addressing diagnosis, monitoring, and prognostication in pediatric neurocritical care. Topics of interest include novel monitoring technologies, biomarker validation, predictive modeling, neuroprotective interventions, and multidisciplinary care models. Global health perspectives and ethical considerations are also welcome.

By uniting diverse expertise, this Special Issue aims to accelerate innovation and shape future standards that improve the lives of children with acute brain injury.

Dr. Kristine Woodward
Prof. Dr. Michael J. Esser
Guest Editors

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Keywords

  • pediatric neurocritical care
  • acute brain injury
  • traumatic brain injury
  • hypoxic–ischemic encephalopathy
  • status epilepticus
  • central nervous system infections
  • stroke in children
  • multimodal neuromonitoring
  • continuous EEG monitoring
  • intracranial pressure monitoring
  • cerebral oxygenation
  • advanced neuroimaging
  • biomarkers
  • neuroprotection
  • prognostic modeling
  • artificial intelligence in critical care
  • seizure detection
  • outcome prediction
  • neurodevelopmental outcomes
  • multidisciplinary critical care

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Published Papers (1 paper)

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Research

15 pages, 2641 KB  
Article
Autonomic Function and Cerebral Autoregulation in Children Receiving Extracorporeal Life Support
by Carlos Castillo-Pinto, Edward Lake, Kin Vong, Thomas V. Brogan and Mark S. Wainwright
Children 2026, 13(3), 409; https://doi.org/10.3390/children13030409 - 16 Mar 2026
Viewed by 491
Abstract
Background/Objectives: Heart rate variability (HRV) and cerebral autoregulation (CAR) reflect physiologic processes that may influence neurological injury in children supported with extracorporeal membrane oxygenation (ECMO). Although abnormalities in both have been associated with adverse neurological outcomes, their physiologic relationship during ECMO remains unclear. [...] Read more.
Background/Objectives: Heart rate variability (HRV) and cerebral autoregulation (CAR) reflect physiologic processes that may influence neurological injury in children supported with extracorporeal membrane oxygenation (ECMO). Although abnormalities in both have been associated with adverse neurological outcomes, their physiologic relationship during ECMO remains unclear. Methods: This retrospective single-center study evaluated the association between HRV and CAR during the first 24 h of ECMO support and assessed their independent relationships with neurological outcome. Patients with at least two hours of simultaneous HRV and CAR monitoring within 24 h of ECMO initiation were included. HRV metrics were derived from artifact-free NN intervals across time, frequency, and nonlinear domains, while CAR was quantified using the cerebral oximetry index (COx), with impaired CAR defined as COx > 0.3. Associations between HRV indices and COx were examined using Spearman correlations at hourly and 24 h resolutions. Unfavorable outcome was defined as death or a Pediatric Cerebral Performance Category (PCPC) score ≥3 at discharge with deterioration from baseline. Results: Eighty-nine patients met inclusion criteria, and 16% demonstrated impaired CAR. HRV measures were reduced relative to age-adjusted norms in both CAR groups without significant differences between groups. Correlations between HRV indices and COx were consistently weak. Overall, 50% experienced unfavorable neurological outcomes. In adjusted logistic regression models, NN skewness and COx were independently associated with outcome, although only NN skewness remained significant in interaction analyses. Conclusions: HRV and CAR exhibited limited physiological coupling during early ECMO support, while each measure provided independent prognostic information with respect to neurological outcome. Full article
(This article belongs to the Special Issue Pediatric Neurocritical Care: Diagnosis, Neuromonitoring and Outcomes)
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