Neurocritical Care Program

What is neurocritical care?

Neurocritical care (sometimes called neurointensive care) identifies and treats life-threatening conditions of the brain, spinal cord and nerves. Neuro means the nervous system.

What is the Neurocritical Care Program?

Seattle Children’s Neurocritical Care Program treats very ill or injured patients with recent serious issues in the brain, spinal cord, nerves and muscles.

Our team features doctors, doctor trainees, psychologists and a social worker who specialize in neurocritical care for babies and children. We help children of all ages with neurologic issues in Seattle Children’s intensive care units (ICUs), during their hospital stay and in our Neurocritical Care Follow-up Clinic after they leave the hospital. We try to prevent any more injury while your child is in the hospital and help your child recover as much as possible.

Learn more about our Neonatal Neurocritical Care Unit (Neuro NICU).

What’s special about Seattle Children’s Neurocritical Care Program?

Our Neurosciences Center is consistently ranked among the nation’s best by U.S. News & World Report. Our providers are interested in and may have special training in neurocritical care, epilepsy, traumatic brain injury, brain disease and diseases involving nerves and blood vessels in the brain (neurovascular). Our psychologist specializes in cognitive tests and treatment recommendations based on your child’s brain injury or condition.
Seattle Children’s team members from the Neurocritical Care Program work together with other hospital teams to develop the best care plan possible. This helps our brain specialists understand what is going on throughout your child’s body and how that affects their nervous system.

This teamwork includes collaboration with our Rehabilitation Medicine team. After a neurologic injury, some children may qualify for inpatient rehabilitation service or they may be better served receiving services from their home. Your child will continue to receive therapies to optimize their recovery, at a pace and intensity personalized to their needs.

Our team also works closely with the Harborview Medical Center Pediatric Intensive Care Unit. Some of our team members serve as doctors in the Harborview PICU. We partner with University of Washington and Harborview Medical Center vascular neurologists if there is a cerebrovascular emergency that may require intervention.
Brain injury and nervous system problems can come in many forms. Some injuries are permanent, while others can be reversed. We follow your child closely and create a custom care plan while in the ICU or hospital and through our follow-up clinic to protect them from more injury and try to help them heal.
Our team conducts cutting-edge research and partners with other leading organizations on this topic. This includes research on:
- Brain injuries in children on extracorporeal membrane oxygenation (ECMO)
- Brain monitoring technology for patients with specific critical illness
- Epilepsy

Conditions We Treat

We care for and treat critically ill and injured children with recent serious issues affecting the brain, spinal cord, nerves and muscles. We also care for children with neurologic issues related to:

Autoimmune disorders
Cardiac arrest
Chemotherapy and radiation therapy
Demyelinating diseases
Infections of the central nervous system
Liver failure
Metabolic disorders (for example, mitochondrial disease, inborn errors of metabolism, Leigh syndrome, mitochondrial encephalomyopathy with lactic acidosis and stroke-like episodes [MELAS])
Neuromuscular disorders (for example, congenital myasthenia gravis, spinal muscular atrophy)
Seizures and epilepsy
Spinal cord diseases
Stroke
Traumatic brain injury

What services do you offer?

Inpatient neurocritical care

Our team monitors and manages your child’s neurologic problems during their hospital stay.

After your child leaves the hospital, it is likely we will see them at our Neurocritical Care Follow-up Clinic. We usually schedule that appointment before you leave the hospital.

Services we offer during your child’s hospital stay may include:

We use the latest technology to monitor, measure and help us understand what is happening in your child’s brain so we can prevent new issues and treat their condition.

We offer:

Imaging:
- MRI (magnetic resonance imaging)
- CT (computed tomography)
- CTA (computed tomography angiography)
- MRA (magnetic resonance angiography)
- MRS (magnetic resonance spectroscopy)
- Transcranial Doppler ultrasound
- Ultrasound
Monitoring:
- EEG (electroencephalography): A test that measures the electrical activity of the brain or brain waves. This can help diagnose seizures or detect changes in your child’s brain function.
- qEEG (quantitative electroencephalography): A test that records the electrical activity in your child’s brain, allowing us to look at changes over time.
- cNIRS (cerebral near infrared spectroscopy): A way to measure blood oxygen in brain tissue.
- Electromyogram and nerve conduction velocity: Tests used to diagnose nerve and muscle problems like nerve damage.
We provide a safe environment after your child’s brain is injured to prevent further injuries in the hospital. Together, with the ICU, we may:
- Keep your child’s body at a controlled temperature to avoid fevers and further brain injury
- Maintain stable electrolytes in a range that keeps the brain healthy and functioning at its best
- Maintain blood flow and oxygen to the brain
- Manage delirium
- Recommend medicines that protect the brain
Neuropsychological testing checks how your child’s brain is developing and working. The tests evaluate memory, thinking, language skills, attention, coordination, senses and personality. The results of these tests can help us provide recommendations to you and your child’s school to enhance their recovery.

Outpatient follow-up care

Our follow-up clinic ensures your child receives ongoing care from brain specialists to have the best recovery possible and avoid additional injury to their nervous system.

Depending on your child’s needs, we may:

Assess your child for therapy services, including occupational, physical or speech therapy
Adjust medicines
Consider additional testing to track your child’s progress
Offer information on how to safely transition your child back to school and their regular daily activities
Evaluate your child for sleep issues, new physical limitations, cognitive changes and mental health issues related to their stay in our ICU. This collection of symptoms after critical illness is referred to as post–intensive care syndrome (PICS). There are two types of PICS:
- Pediatric post–intensive care syndrome (PICS): Describes the long-term effects of being critically ill in the ICU. This can include changes in your child’s physical, mental, cognitive and social health.
- Post–intensive care syndrome-family (PICS-F): Describes the impact that hospitals and health crises have on the family unit after leaving the hospital and frequently includes mental health problems like depression, anxiety and post-traumatic stress disorder. By checking for symptoms and increasing awareness of this syndrome, we can better treat your child and offer resources to your family to help recover from these long-term effects.

We may also perform a variety of tests, including:

A test that measures the electrical activity of the brain, sometimes called the brain waves. This can help diagnose seizures.
Tests used to diagnose nerve and muscle problems. The tests measure how well nerves send signals to the muscles and tell us if there is nerve damage.
These tests look at how your child’s brain is developing and working. They evaluate memory, thinking, language skills, attention, coordination, senses and personality. The results of these tests can help us provide recommendations to you and your child’s school to improve their recovery.

Scheduling an Appointment With the Neurocritical Care Program

How to schedule an appointment at Seattle Children’s. In most cases, we will schedule your child’s follow-up appointment before they are discharged from the hospital.
If you already have an appointment, learn more about how to prepare.
Learn about resources such as useful links, videos and recommended reading for you and your family.

Who’s on the team?

Our team features doctors, doctor trainees, psychologists and social workers who specialize in neurocritical care for babies and children.

We may also collaborate with providers in these specialties:

Providers in our Neurocritical Care Program include:

Leadership

Mark Stephen Wainwright, MD, PhD

Division Chief; Director, Neurocritical Care Program
Amy Lee, MD

Division Chief, Neurosurgery; Fellowship Director; Pediatric Neurosurgery; Associate Residency Program Director, Pediatric Neurosurgery; Co-Director, Neurocritical Care Program
Aniket Joshi, MD

Co-Director, Neurocritical Care Program
Leslie Ann Dervan, MD

Co-Director, Neurocritical Care Program