{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T04:59:42Z","timestamp":1785387582015,"version":"3.55.0"},"reference-count":231,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T00:00:00Z","timestamp":1785369600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Neurol."],"abstract":"<jats:p>Neurological disorders represent a disproportionate fraction of pediatric intensive care unit (PICU) admissions, accounting for approximately one quarter of all critically ill children. These conditions\u2014including traumatic brain injury, hypoxic\u2013ischemic encephalopathy, stroke, infectious and inflammatory disorders, epilepsy, and disorders of consciousness\u2014are frequently accompanied by profound disruption of circadian rhythms. The circadian timekeeper is a fundamental biological system that coordinates physiology across scales, from molecular and cellular processes to systemic functions such as metabolism, immunity, thermoregulation, endocrine signaling, vascular regulation, synaptic physiology, and sleep\u2013wake cycling. In the PICU and neonatal ICU (NICU) environments, multiple factors\u2014including continuous or irregular lighting, noise, frequent clinical interventions, sedation, altered feeding schedules, and the pathophysiology of neurological injury itself\u2014conspire to destabilize circadian organization. We summarize these contributing factors into pathways of critical care circadian desynchrony (C3D). This review examines the intersection between circadian biology and pediatric neurocritical care. We first summarize the molecular and systems-level architecture of the circadian system and distinguish circadian rhythms from sleep\u2013wake state regulation. We then outline the development of sleep and circadian rhythms in the fetus, neonate, infant and child, emphasizing that pediatric circadian biology cannot be treated as a simple extension of adult neurology and chronobiology. We consider how the PICU and NICU environments disrupt circadian biology and discuss how circadian dysregulation manifests across common neurological conditions encountered in pediatric critical care including hypoxic\u2013ischemic encephalopathy (HIE), traumatic brain injury (TBI), stroke, infection and autoimmune encephalitides, epilepsy, delirium, and status dystonicus. Emerging literature suggests that disturbances of circadian outputs\u2014including hormone secretion, metabolism, immune signaling, thermoregulation, sleep\u2013wake cycling, autonomic regulation, and gene expression\u2014may influence neurological injury progression, recovery trajectories, and long-term neurodevelopmental outcomes. We review current methods used to measure sleep and circadian rhythms in critically ill children, including polysomnography, electroencephalography, actigraphy, biomarker-based approaches, and emerging physiological metrics derived from continuous monitoring. Finally, we discuss potential clinical strategies aimed at restoring circadian alignment in the PICU environment, including environmental modification, sedation-aware care, pharmacologic chronobiotics, time-structured nutrition, and chronotherapy. Together, we offer a conceptual framework that centralizes circadian desynchronization in pediatric neurocritical care as an under-explored, potentially targetable modifier of neurological injury and recovery in pediatric critical illness. Integrating circadian biology into pediatric neurocritical care may provide new opportunities for biomarker development, therapeutic intervention, prognostication, and personalized chronomedicine.<\/jats:p>","DOI":"10.3389\/fneur.2026.1826615","type":"journal-article","created":{"date-parts":[[2026,7,30]],"date-time":"2026-07-30T04:22:13Z","timestamp":1785385333000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Circadian rhythms in pediatric neurocritical care: interfaces and opportunities"],"prefix":"10.3389","volume":"17","author":[{"given":"W. Michael","family":"Babinchak","sequence":"first","affiliation":[{"name":"Department of Neurology, Boston Children\u2019s Hospital","place":["Boston, MA, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan O.","family":"Lipton","sequence":"additional","affiliation":[{"name":"Department of Neurology, Boston Children\u2019s Hospital","place":["Boston, MA, United States"]},{"name":"F.M. Kirby Neurobiology Center, Boston Children\u2019s Hospital","place":["Boston, MA, United States"]},{"name":"Division of Sleep Medicine, Harvard Medical School","place":["Boston, MA, United States"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,7,30]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"31","DOI":"10.1016\/j.pediatrneurol.2018.07.013","article-title":"The burden of pediatric Neurocritical Care in the United States","volume":"89","author":"Williams","year":"2018","journal-title":"Pediatr Neurol"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"801","DOI":"10.1097\/pcc.0b013e31828aa71f","article-title":"Hospitalizations of children with neurologic disorders in the United States","volume":"14","author":"Moreau","year":"2013","journal-title":"Pediatr Crit Care 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