Hadassah

Hadassah’s Pediatric Intensive Care Unit: Measuring up to the Highest Standards

Friday, Oct 4 2013

To ensure that the Hadassah Medical Organization's Pediatric Intensive Care Unit (PICU) is achieving the highest international standards of safety, the PICU staff has designed systems to prevent children from picking up infections while hospitalized; to enhance the safety of mechanical ventilation; and to guarantee that medications are given in both safe and effective doses.

Since assuming the medical directorship of the PICU in November 2012, Prof. Philip Toltzis has initiated various programs to improve the efficiency of care. As he explains, the more quickly children can be properly cared for and safely discharged, the larger the number of sick children who will be able to benefit from the advantages of the sophisticated and specialized care the Unit has to offer. Prof. Toltzis relates that admissions this past year have increased by 10 percent.

Hadassah is the only hospital in Israel to have a pediatric neurosurgery service headed up by a pediatric neurosurgeon who is also a pediatric epilepsy surgeon: Dr. Mony Benifla. He has already performed seizure excision surgery on two children successfully, achieving significant reductions in the severity of their seizures. This operation is only considered for children who have epilepsy that cannot be controlled with medications. The surgery begins with the placing of special sensing devices directly on the brain. For several days thereafter, the electrical activity of the child's brain is monitored continuously in the PICU, in collaboration with the pediatric neurology specialists, to identify the exact location where the seizures originate. At the end of the week, that specific area is carefully removed surgically.

Another heart-warming patient story from the PICU concerns Alfendi, an East Jerusalem baby who was born with very complicated heart disease. After his heart was repaired surgically, he experienced electrical heart abnormalities which required insertion of a pacemaker. He also had on-going severe lung problems which required mechanical ventilation and repeated drainage of fluid from his chest. Alfendi spent months in the PICU, with episodes of life-threatening cardiac and respiratory failure, from which he repeatedly made improbable recoveries. Each time after resuscitation, the entire team breathed a sigh of relief.

When he reached about six months of age, Alfendi began to have fewer life-threatening episodes. For the first time ever, he began to smile and interact with people and toys. He remained in Hadassah's PICU, however, because he could not yet be removed from the mechanical ventilator and his community was unable to care for a ventilator-dependent child.

When Alfendi was ten months old, his situation had improved enough that the PICU staff was able begin weaning him from his ventilator. Shortly after his first birthday--which was celebrated in the PICU by his family and all the staff--he was able to live safely and comfortably without the ventilator and his parents could look forward to bringing him home.

Sometimes, the young patients come from other countries, far from Israel. Sergei, a five-year-old from Georgia in the Former Soviet Union, was brought to Israel by his parents because local doctors could not uncover the reason for his fevers and weight loss. The family came directly from Ben Gurion Airport to the pediatric emergency room at Hadassah Hospital- Ein Kerem. Doctors were so concerned by his ill appearance that he was immediately transferred to the PICU. By the end of his first day in Israel, Sergei was diagnosed with lymphoma, a cancer of the lymph glands, which had spread throughout his body.

Because Sergei's tumor was extremely large and the poisons released during chemotherapy could cause serious damage to other organs in his body, the PICU team, in collaboration with Hadassah's pediatric hematology-oncology specialists, decided to begin chemotherapy in the PICU instead of in the Department of Pediatric Hematology-Oncology, where treatment is usually administered. In the PICU, Sergei could be monitored around the clock.

During the first days of treatment, Sergei's blood chemistry tests showed severe abnormalities. Because his breathing was distressed, he needed mechanical ventilation. He also required dialysis when his kidneys failed. The stakes were enormously high. If the staff could get the young boy through the first few days, then his cancer would probably be curable. After a week of meticulous, round-the-clock care, Sergei's complications began to resolve.

Eventually, Sergei's lung and kidney functions returned to normal and there was no evidence of residual cancer. Shortly thereafter, he was healthy enough to travel back to Georgia, where his local doctors could continue his care, in consultation with Hadassah's pediatric oncology specialists.

Alfendi and Surgei are, of course, just two of the many children who are routinely helped in Hadassah's PICU. All of the babies and children admitted to the Unit experience critical periods in their recovery that require constant moment-to-moment monitoring and frequent, life-saving interventions that can only be delivered by an expert intensive care team, with the aid of state-of-the-art equipment.

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