Centralized treatment of critically ill pediatric patients and related problems are presented. Pediatric intensive care allows to overbridge deranged or interrupted organ functions while simultaneously treating the disease causing the disturbance. Its efficiency depends on continuity of medical care. Medical and nursing staff should be trained in the use of specialized equipment, especially monitoring equipment and ventilators. Medical and nursing staff must know who is responsible for the patients all the time. Undivided medical responsibility and coordinated specialist care are essential. Some general points concerning design features, equipment and organisation of a pediatric intensive care unit are made. Some special aspects such as staffing, transportation of high-risk neonates, economy of operation and personal training programm are discussed. Results of pediatric intensive care at the University Children's Hospital Heidelberg are documented. Regionalisation of neonatal care is discussed based on the actuell situation in Baden-Württemberg.