Associations Between Postoperative Management in the Critical Care Unit and Adolescent Developmental Outcomes Following Cardiac Surgery in Infancy: An Exploratory Study*

Abstract

Objectives: Children with congenital heart disease are at high risk for developmental sequelae. Most studies focus on preoperative and intraoperative predictors of developmental impairment, with less attention to the postoperative period. The relationship between patient-related factors specific to the postoperative course in the PICU following cardiac surgery with long-term neurodevelopmental outcomes in adolescence was examined. Design: Retrospective chart review of patients previously recruited to a study describing their developmental outcomes in adolescence. Setting: Single tertiary care pediatric hospital in Canada. Patients: Eighty adolescents, born between 1991 and 1999, with congenital heart disease who required open-heart surgery before 2 years old. Measurements and Main Results: Several variables related to acuity of illness and complexity of postoperative course in the PICU were collected. Outcome measures included the Movement-Assessment Battery for Children-2 (motor), Leiter Brief Intelligence Quotient (cognition), and Strength and Difficulties Questionnaire (behavior). Analyses examined associations between PICU variables and long-term outcomes. Longer mechanical ventilation (β = –0.49; p = 0.013) and dopamine use (β = –14.41; p = 0.012) were associated with lower motor scores. Dopamine use was associated with lower cognitive scores (β = –14.02; p = 0.027). Longer PICU stay (β = 0.18; p = 0.002), having an open chest postoperatively (β = 3.83; p = 0.017), longer mechanical ventilation (β = 0.20; p = 0.001), longer inotrope support (β = 0.27; p = 0.002), hours on dopamine (β = 0.01; p = 0.007), days to enteral feeding (β = 0.22; p = 0.012), lower hemoglobin (β = –0.11; p = 0.004), and higher creatinine (β = 0.05; p = 0.014) were all associated with behavioral difficulties. Conclusions: Several important developmental outcomes in adolescents were associated with factors related to their postoperative course in the PICU as infants. Findings may highlight those children at highest risk for neurodevelopmental sequelae and suggest new approaches to critical care management following open-heart surgery, with the aim of mitigating or preventing adverse long-term outcomes.

Assessment of Long-term Psychological Outcomes After Pediatric Intensive Care Unit Admission

“…Our search strategy identified 9193 records. Of those, 205 full-text articles were assessed for eligibility, and 43 articles consisting of 31 independent studies involving 7786 children admitted to the PICU were included in the systematic review (Figure 1). Of the 31 independent studies, 5 were RCTs, 13 were prospective cohort studies, 10 were retrospective cohort studies, 1 was a case-control study, and 2 were cross-sectional studies .…”

“…Of those, 205 full-text articles were assessed for eligibility, and 43 articles consisting of 31 independent studies involving 7786 children admitted to the PICU were included in the systematic review (Figure 1). Of the 31 independent studies, 5 were RCTs, 13 were prospective cohort studies, 10 were retrospective cohort studies, 1 was a case-control study, and 2 were cross-sectional studies . Findings derived from the same study samples included in 6 of the independent studies (2 of which were RCTs and 4 of which were observational studies) were published in multiple articles (18 total) (eTable 4 in the Supplement).…”

Risk Factors for Physical Function Impairments in Postintensive Care Syndrome: A Scoping Review

“…In addition, the PICS-p framework emphasizes that family and parents are important for children, but these factors do not seem to have attracted much attention in the currently limited literature (45,46). In this review, lower maternal education and incomplete family composition were risk factors for physical function impairments (26,36).…”

“…In addition, assessment of muscle wasting and atrophy via ultrasound or muscle strength via dynamometry were conducted longitudinally during the PICU/hospital stay (25,29). This review is similar to a recent review by Ong et al (34), in which diverse measurement tools were used after PICU discharge, such as the Sleep Disturbance Scale for Children (35), the Chalder Fatigue Scale (26), POSAS (21), and MABC-II (36). Due to the complexity and diversity of the current tools, future research should develop a unique and comprehensive instrument to evaluate physical function impairments in PICU survivors.…”

“…Some studies measured physical function impairments only once, within 6 months after discharge (19,25,26,29,35). Because impairments may last more than 10 years after discharge (21,36), more prospective studies are warranted to determine changes in impairments over time by conducting long-term follow-up studies of survivors. Additional important impairments in adult ICU survivors, including sleep disruption and fatigue, seem to be ignored, but data suggest that these problems also occur in children (26,38,39).…”