The pediatric intensive care unit (PICU) exposes children to stressful experiences with potential long-term psychological repercussions. However, current understanding of post-PICU psychological outcomes is incomplete.OBJECTIVE To systematically review and evaluate reported long-term psychological outcomes among children previously admitted to the PICU.DATA SOURCES A systematic search of the Cumulative Index to Nursing and Allied Health Literature, Embase, MEDLINE (PubMed), and PsycINFO was conducted from database inception to June 2021. Search terms included phrases related to intensive care (eg, intensive care units and critical care) and terms for psychological disorders (eg, posttraumatic stress disorder, depressive disorder, conduct disorder, and neurodevelopmental disorder) limited to the pediatric population.STUDY SELECTION This systematic review and meta-analysis included randomized clinical trials and observational studies reporting psychological disorders among children younger than 18 years who were admitted to the PICU with follow-up for at least 3 months. Psychological disorders were defined using the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition). Children were excluded if they were admitted to the PICU for primary brain conditions (eg, traumatic brain injury, meningoencephalitis, and brain tumors) or discharged to the home for palliative care.DATA EXTRACTION AND SYNTHESIS Titles and abstracts were independently screened by 2 reviewers, with data extraction conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guideline. Data were pooled using a random-effects model during meta-analysis.MAIN OUTCOMES AND MEASURES Age-corrected IQ scores and long-term psychological outcomes measured by scales such as the Child Behavior Checklist (higher scores indicate more behavioral problems) among children admitted to the PICU. RESULTSOf 9193 records identified, 31 independent studies (5 randomized clinical trials and 26 observational studies) involving 7786 children (mean age, 7.3 years [95% CI, years]; 4267 boys [54.8%]; race and ethnicity were not reported by all studies) admitted to the PICU were included. Overall, 1 of 19 children (5.3%) to 14 of 16 children (88.0%) previously admitted to the PICU were reported to have at least 1 psychological disorder. Studies that examined posttraumatic stress disorder reported that 6 of 60 children (10.0%) to 31 of 102 children (30.4%) met the diagnostic criteria for the disorder at 3 to 6 months of follow-up. Compared with healthy children, those admitted to the PICU had lower IQ scores at 1 to 2 years of 89.40 points [95% CI, points] vs 100.70 points [95% CI, 99.43-101.97 points]; P < .001) and 3 to 5 years of follow-up (mean, 88.54 points [95% CI, 83.92-93.16 points] vs 103.18 [95% CI, 100.36-105.99 points]; P < .001) and greater total emotional and behavioral problems at 4 years of follow-up (mean, 51.69 points [95% CI, 50.37-53.01 points] vs 46.66 points [95% CI, points]; P < .001).CONC...

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We describe a child with anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis who had fever of unknown origin (FUO) without encephalopathy or behavioral change. The main neurological symptoms were tremor, truncal ataxia, and postural hypotension. Anti-NMDAR antibodies were present in serum and cerebrospinal fluid. With intravenous immunoglobulin, she made a complete recovery.Children and adolescents who have fever of unknown origin (FUO), defined as temperature more than 38 degrees Celsius for longer than 14 days, are usually prescribed empiric antimicrobial treatment while the underlying cause is being evaluated. 1 This involves obtaining a detailed travel and symptom history, a physical examination, and an array of investigations for an underlying infection, autoimmune disorder, oncologic or genetic etiology. Infections are the most common etiology, but an increasing number of noninfectious causes are now known. 2 To this list, we would add anti-Nmethyl-D-aspartate (NMDAR) receptor encephalitis.Anti-NMDAR receptor encephalitis is a devastating disease. A short prodromal febrile illness usually precedes a fairly characteristic neurological syndrome involving psychiatric symptoms or mood change, encephalopathy, movement disorder, speech or language difficulties, and seizures. Some patients have autonomic dysfunction, respiratory insufficiency, or cerebellar symptoms. 3,4 We report a patient with anti-NMDAR encephalitis who primarily had FUO without prominent neuropsychiatric symptoms or encephalopathy and had less typical disease manifestations. | CASE REPORTThis is a previously well 13-year-old girl who presented to the hospital with a 3-day history of fever, headache, dizziness,