Wafaa Abougabal

Ministry of health, Egypt

Abstract Title:

Beyond Shock: Why We Miss Hypertension in Critically Ill Children

Biography:

Dr. Wafaa Ibrahim Abugabal, MD, IBCLC Pediatric Intensive Care Consultant | Medical Educator | PICU Leader Dr. Wafaa Ibrahim Abugabal is a Pediatric Intensive Care Consultant and Head of Pediatrics and Pediatric Intensive Care Unit at Manshiet El Bakry Hospital, Ministry of Health, Egypt. She also serves as a trainer for the Egyptian Board and Fellowship programs and is actively involved in advancing pediatric critical care education and practice across Egypt. She obtained her Doctorate in Pediatrics from Ain Shams University in 2024 and has extensive experience in pediatric intensive care, emergency medicine, neonatal care, and postoperative cardiac critical care. Throughout her career, she has held leadership and consultant positions at several leading healthcare institutions, including Cleopatra Hospital Group, Wadi El Nile Hospital, Saudi German Hospital, and Ain Shams University Hospitals. Dr. Wafaa has a strong interest in medical education, simulation-based training, and quality improvement. She has developed and delivered numerous educational programs for physicians, nurses, residents, and international trainees, focusing on pediatric critical care, emergency management, and patient safety. Her contributions have also supported successful healthcare accreditation initiatives and the implementation of evidence-based clinical practices. An International Board Certified Lactation Consultant (IBCLC), Dr. Wafaa combines clinical excellence with a passion for teaching and mentorship. Her professional interests include pediatric critical care, hemodynamic monitoring, simulation-based education, quality improvement, and healthcare systems strengthening. She is a member of the Egyptian Society of Pediatric Emergency and Critical Care and remains committed to improving outcomes for critically ill children through clinical innovation, education, and multidisciplinary collaboration.

Research Interests:

Background: Hypertension in critically ill children remains an underrecognized yet clinically significant problem in the Pediatric Intensive Care Unit (PICU). While substantial attention is devoted to identifying and treating hypotension and shock, elevated blood pressure is frequently overlooked despite its association with acute neurological, cardiovascular, and renal complications. Multiple factors contribute to hypertension in critically ill children, including acute kidney injury, chronic kidney disease, fluid overload, pain, agitation, corticosteroid exposure, vasoactive medications, and neurological insults. Objective: To highlight the epidemiology, causes, diagnostic challenges, and management implications of hypertension in critically ill children and emphasize the importance of incorporating systematic blood pressure assessment into routine PICU practice. Methods: A narrative review of contemporary literature was conducted focusing on pediatric hypertension, hypertensive crises, and blood pressure management in critically ill children. Current evidence regarding risk factors, clinical consequences, recognition barriers, and therapeutic approaches was reviewed. Results: Hypertension is common in critically ill pediatric patients and is often multifactorial. Despite its prevalence, delayed recognition remains frequent because clinical attention is typically directed toward hemodynamic instability and shock. Uncontrolled hypertension may lead to hypertensive encephalopathy, seizures, cardiac dysfunction, retinal injury, and worsening renal impairment. Early identification through accurate blood pressure measurement and recognition of age-specific thresholds allows timely intervention and reduction of target-organ injury. Management should focus on treating the underlying cause while implementing individualized antihypertensive therapy when indicated. Conclusion: Hypertension should no longer be considered a secondary concern in pediatric critical care. Recognizing elevated blood pressure as an important marker of disease severity and potential end-organ injury may improve outcomes in critically ill children. Increased awareness, structured monitoring protocols, and prompt intervention are essential to ensure that hypertension does not remain the forgotten vital sign in the PICU.