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Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
Published on: August 25, 2014
Identifying children at high risk for psychological sequelae after pediatric intensive care unit hospitalization
Janet E Rennick1, Isabelle Morin, Doris Kim
1Department of Nursing Research and the Intensive Ambulatory Care Service, Montreal Children's Hospital of the McGill University Health Centre, Montreal, Quebec, Canada. janet.rennick@muhc.mcgill.ca
Insights
Children in pediatric intensive care units (PICUs) exposed to numerous invasive procedures face higher risks of psychological distress post-discharge. Early identification and follow-up are crucial for these high-risk pediatric patients.
Area of Science:
- Pediatric Intensive Care
- Child Psychology
- Critical Illness Recovery
Background:
- Pediatric intensive care unit (PICU) survivors may experience long-term psychological effects.
- Identifying children at high risk for these sequelae is crucial for timely intervention.
Purpose of the Study:
- To identify pediatric intensive care unit (PICU) patients at highest risk for persistent psychological sequelae after hospital discharge.
- To explore the impact of illness severity and invasive procedures on psychological outcomes.
Main Methods:
- Secondary data analysis of children (aged 6-17) hospitalized in PICUs.
- Risk stratification based on illness severity and number of invasive procedures.
- Psychological assessments using validated questionnaires at 6 weeks and 6 months post-discharge.
Main Results:
- High-risk children exhibited significantly more psychological sequelae at 6 weeks and 6 months post-discharge.
- Exposure to a high number of invasive procedures was the strongest predictor of psychological distress at 6 weeks.
- Illness severity also contributed to negative psychological outcomes.
Conclusions:
- A distinct group of PICU patients is at elevated risk for persistent psychological sequelae.
- High numbers of invasive procedures appear to be a key factor driving these adverse psychological outcomes.
- These high-risk children require enhanced monitoring and follow-up care to mitigate long-term effects.
Objective:
To identify those patients in a pediatric intensive care unit who may be at highest risk for developing persistent psychological sequelae after hospital discharge.
Design:
A secondary data analysis was conducted to examine data gathered in an earlier study of children's psychological responses after critical illness. The current study focused exclusively on patients who required pediatric intensive care unit hospitalization.
Patients:
Sixty children, aged 6 to 17 yrs, hospitalized in two Canadian pediatric intensive care units.
Procedures:
Children were categorized as either high risk or low risk for developing persistent psychological sequelae after discharge based on their level of illness severity and the number of invasive procedures to which they were exposed. Outcome data were analyzed using descriptive statistics, followed by an assessment of group differences at baseline, 6 wks, and 6 mos postdischarge. Combined effects of invasive procedures and illness severity on the outcome variables were explored.
Outcome Measures:
Three questionnaires were completed by all children 6 wks and 6 mos postdischarge, including the Children's Impact of Events Scale, the Children's Medical Fears Scale, and the Children's Health Locus of Control Scale.
Results:
Children in the high risk group demonstrated more psychological sequelae 6 wks and 6 mos postdischarge. Exposure to high numbers of invasive procedures was the most important predictor of group differences 6 wks postdischarge.
Conclusions:
Findings suggest there is a group of children in the pediatric intensive care unit who are at higher risk for developing persistent psychological sequelae postdischarge. Exposure to high numbers of invasive procedures may be the driving force behind group differences, particularly at 6 wks postdischarge. These children warrant closer observation and follow-up.
