Neurologic Outcomes Following Care in the Pediatric Intensive Care Unit

Caprarola, Sherrill D; Kudchadkar, Sapna R.; Bembea, Melania M.

doi:10.1007/s40746-017-0092-x

Cited by 16 publications

(11 citation statements)

References 113 publications

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“…Additionally, from birth to age 2 years, myelination and rapid synapse formation are the most active and important processes of cortical development (Kinney et al, 1988;Huttenlocher and Dabholkar, 1997). This all suggests that the timing of neurodevelopmental assessments may also be critical as survivors of childhood critical illness may "grow into" their cognitive deficits if foundational neurodevelopment is affected (Caprarola et al, 2017;Sobotka et al, 2018;Choong, 2019).…”

Section: Developmental Considerations Related To Measuring Cognitive Outcomes In Picu Survivorsmentioning

confidence: 99%

Cognitive Dysfunction After Analgesia and Sedation: Out of the Operating Room and Into the Pediatric Intensive Care Unit

Turner

Sullivan

Drury

et al. 2021

Front. Behav. Neurosci.

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In the midst of concerns for potential neurodevelopmental effects after surgical anesthesia, there is a growing awareness that children who require sedation during critical illness are susceptible to neurologic dysfunctions collectively termed pediatric post-intensive care syndrome, or PICS-p. In contrast to healthy children undergoing elective surgery, critically ill children are subject to inordinate neurologic stress or injury and need to be considered separately. Despite recognition of PICS-p, inconsistency in techniques and timing of post-discharge assessments continues to be a significant barrier to understanding the specific role of sedation in later cognitive dysfunction. Nonetheless, available pediatric studies that account for analgesia and sedation consistently identify sedative and opioid analgesic exposures as risk factors for both in-hospital delirium and post-discharge neurologic sequelae. Clinical observations are supported by animal models showing neuroinflammation, increased neuronal death, dysmyelination, and altered synaptic plasticity and neurotransmission. Additionally, intensive care sedation also contributes to sleep disruption, an important and overlooked variable during acute illness and post-discharge recovery. Because analgesia and sedation are potentially modifiable, understanding the underlying mechanisms could transform sedation strategies to improve outcomes. To move the needle on this, prospective clinical studies would benefit from cohesion with regard to datasets and core outcome assessments, including sleep quality. Analyses should also account for the wide range of diagnoses, heterogeneity of this population, and the dynamic nature of neurodevelopment in age cohorts. Much of the related preclinical evidence has been studied in comparatively brief anesthetic exposures in healthy animals during infancy and is not generalizable to critically ill children. Thus, complementary animal models that more accurately “reverse translate” critical illness paradigms and the effect of analgesia and sedation on neuropathology and functional outcomes are needed. This review explores the interactive role of sedatives and the neurologic vulnerability of critically ill children as it pertains to survivorship and functional outcomes, which is the next frontier in pediatric intensive care.

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Section: Developmental Considerations Related To Measuring Cognitive Outcomes In Picu Survivorsmentioning

confidence: 99%

Cognitive Dysfunction After Analgesia and Sedation: Out of the Operating Room and Into the Pediatric Intensive Care Unit

Turner

Sullivan

Drury

et al. 2021

Front. Behav. Neurosci.

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“…In 2009, Rennick et al . conducted a systematic review of the psychological outcomes but excluded studies on functional PICU outcome 11 ; whilst other systematic reviews have focused on a single outcome 12,13 . A systematic review of multiple long‐term outcomes of PICU may help ensure the optimal use of PICU resources to benefit the most children, whilst minimising long‐term risks.…”

mentioning

confidence: 99%

Outcomes following admission to paediatric intensive care: A systematic review

Procter

Morrow

Pienaar

et al. 2021

J Paediatrics Child Health

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Aim To describe the long‐term health outcomes of children admitted to a paediatric intensive care unit. Methods A systematic review of the literature was performed. Studies of children under 18 years of age admitted to a paediatric intensive care unit were included. Studies focussed on neonatal admissions and investigating specific paediatric intensive care unit interventions or admission diagnoses were excluded. A table was created summarising the study characteristics and main findings. Risk of bias was assessed using the Newcastle Ottawa Quality Assessment Scale for observational studies. Primary outcome was short‐, medium‐ and long‐term mortality. Secondary outcomes included measures of neurodevelopment, cognition, physical, behavioural and psychosocial function as well as quality of life. Results One hundred and eleven studies were included, most were conducted in high‐income countries and focussed on short‐term outcomes. Mortality during admission ranged from 1.3 to 50%. Mortality in high‐income countries reduced over time but this trend was not evident for lower income countries. Higher income countries had lower standardised mortality rates than lower income countries. Children had an ongoing increased risk of death for up to 10 years following intensive care admission as well as increased physical and psychosocial morbidity compared to healthy controls, with associated poorer quality of life. Conclusions There is limited high‐level evidence for the long‐term health outcomes of children after intensive care admission, with the burden of related morbidity remaining greater in poorly resourced regions. Further research is recommended to identify risk factors and modifiable factors for poor outcomes, which could be targeted in practice improvement initiatives.

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“…The cases presented above include children with prolonged hospitalizations, periods of hypoxia, and multiple surgical and invasive interventions. All of these factors increase the risk of abnormal neurodevelopmental outcomes [12].…”

Section: Discussionmentioning

confidence: 99%

The tale of two omphaloceles: Same treatment, different outcomes

Kamm¹,

Grassham²,

Rael³

et al. 2018

Ann Pediatr

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Omphaloceles are one of the most common abdominal wall defects, and unfortunately multiple long-term medical problems can occur as a result. Specifically, other structural and chromosomal abnormalities may be present in the setting of an omphalocele. Treatment options vary depending on the size of the defect, with a common option being the "paint and wait" technique, in which a topical agent is applied that allows epithelialization over the amnion sac. Here, we discuss two such cases of omphalocele, and although both received the same treatment, very different outcomes occurred.

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Neurologic Outcomes Following Care in the Pediatric Intensive Care Unit

Cited by 16 publications

References 113 publications

Cognitive Dysfunction After Analgesia and Sedation: Out of the Operating Room and Into the Pediatric Intensive Care Unit

Cognitive Dysfunction After Analgesia and Sedation: Out of the Operating Room and Into the Pediatric Intensive Care Unit

Outcomes following admission to paediatric intensive care: A systematic review

The tale of two omphaloceles: Same treatment, different outcomes

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