Cognitive Impairment Following Pediatric Critical Illness: Time to Pay Attention*

Madurski, Catherine; Treble‐Barna, Amery; Fink, Ericka L.

doi:10.1097/pcc.0000000000001436

Cited by 5 publications

(5 citation statements)

References 17 publications

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“…ICU hospitalization is a major life event for both children and families [2,5], which can constitute early adversity and result in impairment in various fields [4][5][6]. During ICU hospitalization, risk factors for cognitive impairment are multiplied [4,[6][7][8], while positive cognitive stimuli are reduced [9][10][11]. Relevant stressors include risk factors such as exposure to strangers, medical environments and psychological stress as well as removal of protective factors such as separation from the family and familiar environments [4,6,8].…”

Section: Introductionmentioning

confidence: 99%

“…Neonatal ICU (NICU) and pediatric ICU (PICU) survivors have been found to suffer from common psychiatric disorders, including depression, anxiety and post-ICU syndromes [5,6,13,14], and from new or increasing impairments in various cognitive functions [6][7][8]. Major identified risk factors which account for these impairments are both the critical illness itself in addition to elements related to hospitalization in and of itself.…”

Section: Introductionmentioning

confidence: 99%

“…The focus of this review lies in ICU hospitalization for two main reasons. First, compared to a general hospitalization, an ICU admission is more severe and has a greater influence post-discharge on survivors [6][7][8]. As examining the hypothesized association is complicated, it is hoped that choosing to focus on an ICU hospitalization will facilitate establishing and analyzing this possible association.…”

Section: Introductionmentioning

confidence: 99%

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A systematic review of the impact of intensive care admissions on post discharge cognition in children

Royer

Busari

2021

Eur J Pediatr

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Understanding how hospitalization affects cognitive development is crucial to safeguard children’s cognition; however, there is little research evaluating the associations between NICU or PICU hospitalization and survivors’ cognition. The objective of this study is to identify and characterize the associations between a neonatal or pediatric ICU hospitalization and the short- and long-term cognition of survivors. The databases Cochrane Library, Medline, EBSCO, Embase, and Google Scholar and the journals JAMA Pediatrics, Journal of Pediatrics, Pediatrics, Archives of Disease in Childhood, Academic Pediatrics, Pediatric Critical Care Medicine and Child Development were searched until April 2021. Retrieved article references were analyzed. Included articles investigated cognition as an outcome of ICU hospitalization in non-preterm neonatal or pediatric patients. Case studies and studies analyzing diagnosis or treatment interventions were excluded. Four prospective cohort or case-control studies and two retrospective cohort studies were included, totaling 2172 neonatal and 42368 pediatric patients. Quality assessment using the BMJ Criteria and Cochrane Collaboration’s Risk-of-Bias tool displayed good results. Significant negative associations were found between neonatal cognition and length-of-ICU-stay at 9- (p<0.001) and 24 months (p<0.01), and between pediatric cognition and length-of-ICU-stay at discharge (p<0.001). Additional weeks on the neonatal ICU increased odds of impairment at 9- (OR 1.08, 95%CI 1.034–1.112) and 24 months (OR 1.11, 95%CI 1.065–1.165).Conclusion: There is a significant negative correlation between NICU and PICU hospitalization and the short- and long-term cognitive status. Future research must identify patient- and hospital-related risk factors and develop management strategies. What is Known:• Cognitive development relies on the presence of stimulating factors and absence of risk factors, and is hypothesized to be directly and indirectly affected by hospitalization in the short and long term.• No research examines the relation between survivor cognition post-discharge of a general pediatric hospitalization, and scarcely more of a neonatal or pediatric intensive care hospitalization. What is New:• NICU and PICU hospitalization is independent risk factors for survivor impaired cognition in the short and in the long term with a dose-response effect. High risk patients for cognitive impairment should be identified and appropriately followed-up.• Patients with an ICU hospitalization of over 2.5 days and two or more of the following factors should be considered high risk: increased mortality risk, invasive interventions, neurological or oncological diagnosis, postnatal complications or decreased maternal mental health status.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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A systematic review of the impact of intensive care admissions on post discharge cognition in children

Royer

Busari

2021

Eur J Pediatr

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“…The traditional outcome measure used in ECMO patients is in‐hospital mortality. However, this has obvious limitations, and there have been calls to examine more robust outcome measures, such as 1‐year survival with adequate neurologic and functional recovery 146 …”

Section: Ecmo Outcomesmentioning

confidence: 99%

“…However, this has obvious limitations, and there have been calls to examine more robust outcome measures, such as 1-year survival with adequate neurologic and functional recovery. 146 As an example of mortality after decannulation from ECMO, a 2017 review of 400 neonates and children who survived ECMO showed approximately a 10% mortality rate between decannulation and 90 days, with 84% of neonates and 74% of pediatric patients surviving to decannulation, and 76% and 66% alive at 90 days, respectively. 147 Furthermore, a long-term survival review, with a median follow-up time of 7 years for neonates and pediatrics patients who underwent ECMO support in the United Kingdom, demonstrated a 6% mortality >90 days after ECMO.…”

Section: Ecmo Outcomesmentioning

confidence: 99%

Hematologic concerns in extracorporeal membrane oxygenation

Sniderman

Monagle

Annich

et al. 2020

Research and Practice in Thrombosis and Haemostasis

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This ISTH “State of the Art” review aims to critically evaluate the hematologic considerations and complications in extracorporeal membrane oxygenation (ECMO). ECMO is experiencing a rapid increase in clinical use, but many questions remain unanswered. The existing literature does not address or explicitly state many pertinent details that may influence hematologic complications and, ultimately, patient outcomes. This review aims to broadly introduce modern ECMO practices, circuit designs, circuit materials, hematologic complications, transfusion‐related considerations, age‐ and size‐related differences, and considerations for choosing outcome measures. Relevant studies from the 2019 ISTH Congress in Melbourne, which further advanced our understanding of these processes, will also be highlighted.

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