The first PICUs in Spain were established in 1968 at the Hospital Infantil Valle de Hebrón (Barcelona) and the following year, in 1969, at the Hospital Infantil La Paz in Madrid, initially as surgical neonatal intensive care units. In those early stages, new PICUs began operating at Social Security hospitals in Bilbao, Valencia, Seville, the “Hospitales Clínicos” in Barcelona, Granada, Santiago de Compostela, the Hospital Niño Jesús and the Hospital Gregorio Marañón in Madrid, and the hospital in San Sebastián. Very soon, in the 1970s, the number of pediatric intensive care units (PICUs) increased dramatically in newly founded children’s hospitals. According to the most recent update, there are 52 PICUs of all levels in Spain.1

Not only did the number of pediatric intensive care units (PICUs) and pediatric intensivists increase in Spain, but the very establishment of these units gradually gave rise to a new way of organizing children’s hospitals, starting by concentrating care for the most critically ill children in a specific area of the facility. In turn, this promoted a new vision of hospital organization based, from that point forward, on levels of care, concentrating material resources and specialized personnel in the PICUs. This improved not only the quality of care for critically ill patients, but also hospital management by allowing a reduction in the use of health care resources on other areas of the hospital. The development of pediatric intensive care (PIC) run parallel to that of complex pediatric surgery, enabling high-quality postoperative care through the implementation of the increasingly advanced supportive therapies required to achieve the desired favorable outcomes. All of these factors have undoubtedly contributed to the substantial decline in infant mortality in Spain. Based on data from the National Institute of Statistics of Spain (INE), both neonatal and under-five mortality have decreased significantly since 1975 (Figs. 1 and 2).

Figure 1.

https://www.ine.es/jaxiT3/Datos.htm?t=29475#_tabs-grafico.

Figure 2.

https://www.ine.es/jaxiT3/Datos.htm?t=29286#_tabs-grafico.

Thus, the emergence of pediatric intensive care had two significant consequences: the most important was the indisputable improvement in the quality of care for the most seriously ill or injured patients, and the second was the improved management of human and material resources, with a clear impact in terms of reduced health care costs.

Motivated by the need to promote and coordinate the activities of these pediatric specialists, on July 16, 1976, four of them, who at the time were pioneers in this field in Spain (Xavier Allúe in Bilbao, Juan Iglesias in Barcelona, José Luís Manzano in Valencia, and Francisco Javier Ruza in Madrid) submitted a written request to Professor Ernesto Sánchez Villares (president of the AEP) to create the Pediatric Intensive Care Section of the AEP. The AEP, an association that brought together pediatricians from all over Spain, was beginning to develop working groups on pediatric subspecialties. In that letter, the applicants justified their request on the grounds that: (a) PICUs already existed in hospitals and pediatric departments throughout Spain, operating as an integrated part of those facilities; (b) PIC met the technical and scientific criteria required to qualify as a specialty; (c) there was a need to join efforts to improve patient outcomes; (d) PIC was a genuine field of clinical practice focused on serious illness within the scope of pediatric care; (e) they accepted the regulations governing the specialized Sections that the AEP was incorporating at the time; (f) members of this section agreed to become members of the AEP; (g) they sought to contribute to the official journal of the AEP, Anales Españoles de Pediatría, in order to disseminate knowledge, protocols, etc, related to the specialty through editorials, articles, reports, etc; (h) the PIC Section committed to regulating the access of pediatricians to the specialty.

The application implied that this specialty was hospital-based and that the care of critically ill children had to be comprehensive, addressing the whole patient. During the 14th Congress of Pediatrics, held in Barcelona in 1976, the establishment of this specialized section was approved.

In 1996, twenty years later, the growth and development of pediatric intensive care in Spain was so significant that the initial specialized section evolved into the Sociedad Española de Cuidados Intensivos Pediátricos (SECIP). The Pediatric Group of the Sociedad Española de Medicina Intensiva y Unidades Coronarias (SEMIUC, Spanish Society of Intensive Care and Coronary Care Units) was incorporated into it. This united all Spanish pediatric intensivists under a single scientific society, making the SECIP the true representative of pediatric intensive care.

One of the tasks led by the various SECIP executive boards to promote the fulfilment of the society's objectives has been the preparation of technical reports (four to date), framework documents intended to disseminate the theoretical foundations of the pediatric intensive care specialty, establish the organizational requirements for the implementation of new units, and design the training pathway for pediatric intensivists. Educational aspects have also been addressed in detail in Appendix 1 of the latest edition of the White Paper on Pediatric Specialties, which concerns PIC medicine.1–5

Soon, the concerns that led to the creation of national scientific societies spurred the formation of international societies.

In Europe, a group of pediatric intensivists was formed by simply bringing together the few pediatric specialists who were providing this type of care at the time. This first group was called the European Club of Paediatric Intensive Care (ECPIC). Spain has the honor of having founded this Club during the 14th National Congress of Pediatrics held in Barcelona in 1976 (in which pediatric intensivists from other countries participated as speakers), so that the founding of this Club coincided with the founding of the PIC section within the AEP. The ECPIC included pediatric intensivists from 10 to 12 European countries. It held meetings that rotated from country to country to exchange experiences and knowledge while promoting the recruitment of new members and the creation of new PICUs. This club was the original core from which, ten years later (1986), a true international scientific society developed: the European Society of Pediatric Intensive Care (ESPIC), which changed its name in 1998 to European Society of Pediatric and Neonatal Intensive Care (ESPNIC).

The ESPIC further developed the role and activities of the previous club, adding to its mission the promotion of the specialty at the international level. Dr Ruza, a founding member and vice president of its first board of directors, was tasked with promoting pediatric intensive care in Spain and Portugal, and later expanded this effort to include all of Latin America.

In keeping with this commitment, he made numerous trips to those countries over many years, teaching courses and participating in conferences and symposia on PIC. In addition, many of the pediatric specialists at the Hospital Infantil La Paz furthered their training on PIC under his leadership.

In 1992, the World Federation of Pediatric Intensive Care (WFPIC) was established, thereby completing the global representation of our specialty. This was followed in 1995 by the founding of the Sociedad Latinoamericana de Cuidados Intensivos Pediátricos (SLACIP, Latin American Society of Pediatric Intensive Care), which has counted with the collaboration of the SECIP from its inception.

Today, the SECIP has more than 630 associate members; most of whom participate in one or more of the 17 working groups that are currently active. These groups have become the actual driving force behind the society, promoting research and educational activities through courses and specialized workshops on a wide variety of techniques and topics related to PIC, and developing proposals for discussions and debates to be held at the annual conferences, which bring together more than 300 professionals.

In addition, the SECIP organizes and funds a course for pediatric residents interested in pursuing more specialized training in pediatric intensive care. More recently, the society has contributed to the advancement of research and education by launching its own open-access, bilingual journal, Pediatría Crítica (https://revistapediatriacritica.com), and a Master’s program in the Fundamentals of Pediatric Intensive Care (http://mastersecip.com), both of which are gaining significant recognition throughout the Spanish-speaking world.

More than three years ago, the SECIP submitted the necessary documentation to request the establishment of Pediatric Intensive Care as a recognized subspecialty or specific training area (known as ACE in Spain), in accordance with current legislation.6,7 However, for various reasons, there has been no progress in this direction. The lack of development of the ACEs has, so far, precluded the possibility of becoming accredited as a pediatric intensivist.

This void has been compensated, to the extent possible, by the certification issued by the SECIP and endorsed by the AEP to pediatricians who demonstrate ongoing dedication to the field and provide proof of the necessary training in PIC.

Obtaining official recognition for our specialty is one of our outstanding challenges, but it is not the only one, nor the most important. Ensuring the provision of effective and comprehensive care for seriously ill children will continue to be our primary pursuit, as it has been from the very beginning. To achieve this, we must maintain the enthusiasm of the pioneers, while making intelligent use of all resources that can strengthen our clinical competence, in a patient-centered approach and without losing sight of our ethical commitment.