Outcomes following admission to paediatric intensive care: A systematic review

Abstract

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.

Impact of critical illness and withholding of early parenteral nutrition in the pediatric intensive care unit on long-term physical performance of children: a 4-year follow-up of the PEPaNIC randomized controlled trial

“…The finding of a decreased physical functional capacity in the long term after PICU discharge is consistent with other studies, with a highly variable post-PICU follow-up time window [ 12 ]. However, virtually all these studies used qualitative assessments of general functional status based on a wide variety of questionnaires or scales [ 12 – 14 , 38 ].…”

“…The finding of a decreased physical functional capacity in the long term after PICU discharge is consistent with other studies, with a highly variable post-PICU follow-up time window [ 12 ]. However, virtually all these studies used qualitative assessments of general functional status based on a wide variety of questionnaires or scales [ 12 – 14 , 38 ]. Only few objective quantitative data are available and this only from small studies (fewer than 50 patients), mostly performed in specific subgroups of former PICU patients.…”

“…Certain domains have also been extensively documented with the use of objective, quantitative measurements such as anthropometrics to assess growth and a wide range of neurocognitive function tests to evaluate neurocognitive development [ 4 , 5 , 9 – 11 ]. General assessment of long-term physical functional capacity in daily life after critical illness, however, still remains limited to the use of scales and questionnaires [ 12 – 14 ].…”

Prevalence of Feeding and Swallowing Disorders in Congenital Heart Disease: A Scoping Review

“…FSD are one of the most common morbidities following cardiac surgery noted by both families and clinicians, have an impact on quality of life, and are associated with increased PICU and hospital stays, as well as significantly higher hospital costs ( 30 ). In addition, with the knowledge that FSD in this population changes over time and may still be present years after surgery ( 16 ), and the current focus on long-term follow-up and outcomes of patients admitted to the PICU ( 31 ), ongoing surveillance of swallowing function and FSD outcomes should form part of the long-term management of infants and children with CHD.…”

Nursing-Sensitive Outcomes among Patients Cared for in Paediatric Intensive Care Units: A Scoping Review

“…Lastly, for nurse managers, this contribution might address issues in measuring nursing care as well as in improving its quality. According to these multiple implications, a comprehensive overview on nursing outcomes in PICUs is called for [ 14 ]. Specifically, this review is aimed at mapping out the current literature on NSOs in PICUs by exploring all outcomes conceptualised to date.…”