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Neurobehavioural outcomes in children after In-Hospital cardiac arrest
Beth S Slomine1, Faye S Silverstein2, James R Christensen1
1Kennedy Krieger Institute, 707 North Broadway, Baltimore, MD 21205, United States; Johns Hopkins University, School of Medicine, Baltimore, MD 21205, United States.
Insights
Pediatric cardiac arrest survivors experienced significant neurobehavioral declines after hospital resuscitation. While most maintained broadly normal scores, functioning worsened notably from baseline, persisting at 12 months.
Area of Science:
- Pediatric neurology
- Neuroscience
- Clinical trials
Background:
- Children comatose after in-hospital cardiac arrest (IH-CA) face risks of poor neurological outcomes.
- Targeted temperature management (TTM) trials like THAPCA-IH evaluate interventions for these children.
- Neurobehavioral assessment is crucial for understanding long-term recovery in pediatric IH-CA survivors.
Purpose of the Study:
- To assess detailed neurobehavioral functioning in pediatric IH-CA survivors initially comatose after resuscitation.
- To evaluate changes in adaptive behavior and cognitive function over time using the Vineland Adaptive Behavior Scales, Second Edition (VABS-II).
- To compare neurobehavioral outcomes between TTM interventions (hypothermia vs. normothermia) in the THAPCA-IH trial.
Main Methods:
- Enrolled children aged 2 days to 18 years in the THAPCA-IH trial (NCT00880087).
- Focused on children with broadly normal pre-IH-CA VABS-II scores (composite ≥70; n=269).
- Administered VABS-II at baseline, 3 months, and 12 months; cognitive testing at 12 months (n=125 one-year survivors).
Main Results:
- Seventy-seven percent (96/125) of survivors had VABS-II scores ≥70 at 12 months.
- Cognitive composite scores were ≥2 standard deviations below the mean in 59% of children.
- Significant declines in VABS-II composite and domain scores were observed between baseline and 3-month/12-month assessments (mean composite decline ~1 SD).
Conclusions:
- Paediatric IH-CA survivors at high risk show significant neurobehavioral declines across multiple domains.
- Neurobehavioral functioning remained relatively stable between 3 and 12 months post-event.
- Despite declines, approximately three-quarters achieved VABS-II composite scores within the broadly normal range at 12 months.
Aim:
Children who remain comatose after in-hospital cardiac arrest (IH-CA) resuscitation are at risk for poor neurological outcome. We report results of detailed neurobehavioural testing in paediatric IH-CA survivors, initially comatose after return of circulation, and enrolled in THAPCA-IH, a clinical trial that evaluated two targeted temperature management interventions (hypothermia, 33.0 °C or normothermia, 36.8 °C; NCT00880087).
Methods:
Children, aged 2 days to <18 years, were enrolled in THAPCA-IH from 2009 to 2015; primary trial outcome (survival with favorable neurobehavioural outcome) did not differ between groups. Pre-IH-CA neurobehavioural functioning, measured with the Vineland Adaptive Behavior Scales, Second Edition (VABS-II) was evaluated soon after enrollment; this report includes only children with broadly normal pre-IH-CA scores (VABS-II composite scores ≥70; 269 enrolled). VABS-II was re-administered 3 and 12 months later. Cognitive testing was completed at 12 months.
Results:
Follow-ups were obtained on 125 of 135 eligible one-year survivors. Seventy-seven percent (96/125) had VABS-II scores ≥70 at 12 months; cognitive composites were ≥2SD of mean in 59%. VABS-II composite, domain, and most subdomain scores declined between pre-IH-CA and 3-month, and pre-IH-CA and 12-month assessments (composite means declined about 1 SD at 3 and 12 months, p < 0.005); 3 and 12-month scores were strongly correlated (r = 0.72, p < 0.001).
Conclusions:
In paediatric IH-CA survivors at high risk for unfavorable outcomes, the majority demonstrated significant declines in neurobehavioural functioning, across multiple functional domains, with similar functioning at 3 and 12 months. About three-quarters attained VABS-II functional performance composite scores within the broadly normal range.
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