Oregon Health & Science University
  • Juan Piantino, M.D.Juan Piantino, M.D.
    In addition to directing the inpatient pediatric neurology service at OHSU Doernbecher Children's Hospital, Dr. Piantino coordinates the Pediatric Neurocritical Care follow-up clinic. He has advanced training in pediatric neurocritical care, clinical neurophysiology and pediatric neurology.

    Cydni Williams, M.D.Cydni Williams, M.D.
    Dr. Williams is a pediatric critical care physician at OHSU Doernbecher Children's Hospital. She specializes in pediatric neurocritical care and coordinates the Pediatric Neurocritical Care follow-up clinic. Dr. Williams has expertise in and research funding to study outcomes in these children in order to determine eff ective interventions to improve outcomes.

After the ICU: Unique clinic helps kids recover from neurological injuries

No longer acutely ill, but not well. Poor school performance, headaches, anxiety — these are just some of the sequelae of serious neurological conditions. A child may be released from the hospital, but suffer a range of physical, psychosocial and emotional symptoms termed postintensive care syndrome, or PICS.

Children who have spent time in the pediatric ICU for neurological care may emerge with concerns that fall into a "care gap" between those with less severe injuries, such as concussion, and severely disabled children who need residential care. Juan Piantino, M.D., and Cydni Williams, M.D., coordinate the Pediatric Neurocritical Care follow-up clinic for these patients at OHSU Doernbecher Children’s Hospital. The clinic connects children, families and primary providers with the specialized expertise and techniques these children need to optimize recovery.

Which children need follow-up?

The clinic cares for children previously admitted to the Doernbecher intensive care unit with a primary neurological concern, such as a traumatic brain injury, seizure, stroke or meningitis. In addition, the team sees children who were admitted to the pediatric ICU with another concern, such as a cardiac arrest, who have a neurological complication such as a subsequent stroke.

Conditions treated

Children treated in the follow-up clinic most commonly have:

  • Traumatic brain injury, often related to a car crash, pedestrian vs. vehicle, or bicycle accident
  • Brain infections, e.g., meningitis or abscess-related disease
  • Primary infl ammatory conditions of the central nervous system
  • Stroke
  • Seizure disorders

The clinic works with James Chesnutt, M.D., of the OHSU Sports Medicine Clinic, to care for children with concussion and provide comprehensive care for children with more severe symptoms than in typical post-concussion syndrome. The team also follows children with neurological complications of cardiac disease.

Problems after neuro PICU care

Children hospitalized in the pediatric ICU for neurological care may have the following even after discharge:

  • Seizures
  • Sleep problems
  • Headaches
  • Depression and anxiety
  • School problems ranging from inattention to poor school performance and discipline issues

“These conditions carry a potentially heavy public health cost. For example, children lose time from school as well as developmental opportunities. Parents and caregivers bear and pass on economic costs if they have to miss work regularly to care for an ill child.”

— Juan Piantino, M.D., Director, inpatient Pediatric Neurology, OHSU Doernbecher Children’s Hospital, and coordinator, Pediatric Neurocritical Care follow-up clinic

Our team — A unique regional resource

OHSU Doernbecher’s neuro PICU follow-up clinic is the only one of its kind on the West Coast, in part because few providers off er the team’s breadth and depth of expertise. Piantino directs the clinic with a highly specialized combination of expertise in pediatric neurology, pediatric neurocritical care and epilepsy and TBI in children. In her role as an intensivist, Williams identifi es Doernbecher ICU patients who are candidates for the neuro follow-up clinic and connects them with its resources.

Neuropsychologist Daniel Kriz, Psy.D., evaluates patients shortly before discharge, three months after discharge and at six to 12 months post-hospitalization. Addressing neuropsychological needs is as crucial to recovery as neurologic care, and spacing the neuropsychiatric evaluations allows time for children to heal and make progress between appointments. Patients also see Piantino in the follow-up clinic. Nationally, few clinics offer this mix of skills for pediatric patients.

Busy clinic reveals important regional need

Launched in September 2016, the follow-up clinic has grown from seeing patients one day each month, to two. The number of families who have embraced this resource attests to the far-reaching and debilitating nature of the issues children face. Now, the directors plan to expand the clinic to three or four days per month, and add providers in physical, occupational and speech therapy.

Connecting children and primary providers with continued care

Children who experience symptoms after their follow-up clinic appointments may continue seeing Piantino for neurologic care and Kriz as needed. As the clinic adds rehabilitation providers, the options for continuing care will expand.

Getting to the clinic

The clinic is located at OHSU Doernbecher Children’s Hospital. The neurologic evaluation takes 30 to 45 minutes, and the neuropsychology appointment 60 to 90 minutes. Families from more than 35 miles away may choose to stay overnight in Portland.

Contact us

The neuro ICU follow-up clinic does not take direct referrals, but children treated in the OHSU Doernbecher ICU are evaluated for follow-up needs. To refer a patient with a neurologic condition, or for more information about the clinic, the pediatric neurology team is always available for consultation. For a consultation, please call the OHSU Physician Consult & Referral Service at 503-346-0644. To refer a patient, please fax to 503-346-0645.

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