Recurrent delirium after surgery for congenital heart disease in an infant

Area of Science:

• Pediatric Critical Care Medicine
• Pediatric Cardiology
• Neurocritical Care

Background:

• Delirium is a frequent yet often overlooked complication in pediatric intensive care units (PICUs).
• Post-cardiac surgery delirium can negatively impact neurocognitive outcomes and prolong hospital stays in infants.
• Early identification and management of delirium are crucial for optimizing patient recovery.

Observation:

• A male infant with hypoplastic left heart syndrome developed recurrent episodes of delirium during consecutive admissions to the PICU post-cardiac surgery.
• Symptoms of delirium were observed on two separate occasions following surgical interventions.
• The infant received pharmacologic intervention with olanzapine, an atypical antipsychotic.

Findings:

• The administration of olanzapine led to the resolution of delirium symptoms during both episodes.
• Continuous olanzapine treatment was associated with symptom improvement and management.
• This case demonstrates the efficacy of olanzapine in treating delirium in an infant post-cardiac surgery.

Implications:

• Effective management of pediatric delirium may reduce the need for sedatives like narcotics and benzodiazepines.
• Prompt treatment of delirium could potentially shorten intensive care unit length of stay.
• Addressing delirium early may contribute to improved long-term neurocognitive function in pediatric patients.