Surviving pediatric intensive care: physical outcome after 3 months
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Hendrika Knoester1, Madelon B Bronner, Albert P Bos
1Pediatric Intensive Care Unit, Emma Children's Hospital, Academic Medical Center, Meibergdreef 9, Amsterdam, The Netherlands. h.knoester@amc.uva.nl
Insights
Pediatric intensive care unit (PICU) survivors often experience physical sequelae, with 69% showing impairments. Neurocognitive outcomes improved by 3 months post-discharge, but overall performance remained affected, highlighting the need for follow-up care.
Area of Science:
- Pediatric critical care medicine
- Neuroscience
- Rehabilitation medicine
Background:
- Pediatric intensive care unit (PICU) survivors face potential long-term health challenges.
- Understanding the prevalence and types of sequelae is crucial for effective patient management.
- Previous research has not fully elucidated the spectrum of physical and neurocognitive deficits post-PICU discharge.
Purpose of the Study:
- To investigate the incidence and characteristics of physical and neurocognitive sequelae in children following PICU admission.
- To assess the recovery trajectory of neurocognitive function at 3 months post-discharge.
- To identify potential risk factors or complications contributing to sequelae.
Main Methods:
- Prospective follow-up study conducted 3 months after PICU discharge.
- Inclusion of 186 previously healthy children admitted to a tertiary PICU.
- Utilized Pediatric Cerebral Performance Category (PCPC) and Pediatric Overall Performance Category (POPC) for assessments.
Main Results:
- 69% of children exhibited physical sequelae, with 39% due to acquired morbidity and 8% linked to PICU procedure complications.
- At 3 months post-discharge, 77% of children had normal PCPC scores, indicating neurocognitive recovery.
- However, only 31% of children had normal POPC scores, suggesting persistent functional deficits.
Conclusions:
- PICU survival is frequently associated with significant physical sequelae.
- While neurocognitive function shows improvement, overall performance deficits persist in a substantial proportion of survivors.
- Structured, multicenter follow-up studies are essential to comprehensively evaluate and manage PICU survivors.
Objective:
This study investigated the prevalence and nature of physical and neurocognitive sequelae in pediatric intensive care unit (PICU) survivors.
Design And Setting:
Prospective follow-up study 3 months after discharge from a 14-bed tertiary PICU in The Netherlands.
Patients And Participants:
The families of 250 previously healthy children unexpectedly admitted to the PICU were invited to visit the outpatient follow-up clinic for structured medical examination of the child 3 months after discharge; 186 patients were evaluated.
Measurements And Results:
Pediatric Cerebral Performance Category (PCPC) and Pediatric Overall Performance Category (POPC) values were determined at PICU discharge, at the outpatient follow-up clinic, and retrospectively before admission to the PICU. We found that 69% of children had physical sequelae. In 30% of cases these were caused by a previously unknown illness and in 39% by acquired morbidity. In 8% of the children the acquired morbidity was related to complications from PICU procedures. Three months after discharge 77% of the children had normal PCPC scores and 31% had normal POPC scores.
Conclusions:
Our results indicate that PICU survival may be associated with substantial physical sequelae. Structured follow-up research, preferably by multicenter studies, is warranted in PICU survivors.
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