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A Systematic Review of Risk Factors Associated With Cognitive Impairment After Pediatric Critical Illness
Alicia G Kachmar1,2, Sharon Y Irving1,3, Cynthia A Connolly1
1Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia, PA.
Insights
Children who experience critical illness may face cognitive impairment. Risk factors include younger age during illness, older age at follow-up, low socioeconomic status, and treatments like mechanical ventilation or sedation.
Area of Science:
- Pediatric Critical Care Medicine
- Neuropsychology
- Child Development
Background:
- Children surviving critical illness may experience long-term cognitive deficits.
- Identifying risk factors is crucial for targeted interventions and improved outcomes.
Purpose of the Study:
- To systematically review and identify risk factors for cognitive impairment in neurotypical children following critical illness.
Main Methods:
- A systematic review of studies published from January 1960 to March 2017.
- Searched multiple databases including PubMed, Scopus, and Embase.
- Included studies on children aged 3-18 years assessed with standardized neuropsychological tests, excluding those with pre-existing neurological conditions.
Main Results:
- Ten of twelve studies found significantly lower cognitive scores in children post-critical illness compared to controls.
- Seven studies reported deficits in multiple cognitive domains.
- Identified risk factors include younger age at critical illness, older age at follow-up, low socioeconomic status, high oxygen needs, and use of mechanical ventilation, sedation, and pain medications.
Conclusions:
- Younger age during critical illness and specific medical interventions are associated with cognitive impairment.
- Understanding these risk factors can guide clinical practice and support services for high-risk children.
Objectives:
To identify risk factors associated with cognitive impairment as assessed by neuropsychologic tests in neurotypical children after critical illness.
Data Sources:
For this systematic review, we searched the Cochrane Library, Scopus, PubMed, Ovid, Embase, and CINAHL databases from January 1960 to March 2017.
Study Selection:
Included were studies with subjects 3-18 years old at the time of post PICU follow-up evaluation and use of an objective standardized neuropsychologic test with at least one cognitive functioning dimension. Excluded were studies featuring patients with a history of cardiac arrest, traumatic brain injury, or genetic anomalies associated with neurocognitive impairment.
Data Extraction:
Twelve studies met the sampling criteria and were rated using the Newcastle-Ottawa Quality Assessment Scale.
Data Synthesis:
Ten studies reported significantly lower scores in at least one cognitive domain as compared to healthy controls or normed population data; seven of these-four case-control and three prospective cohort studies-reported significant lower scores in more than one cognitive domain. Risk factors associated with post critical illness cognitive impairment included younger age at critical illness and/or older age at follow-up, low socioeconomic status, high oxygen requirements, and use of mechanical ventilation, sedation, and pain medications.
Conclusions:
Identifying risk factors for poor cognitive outcomes post critical illness may help healthcare teams modify patient risk and/or provide follow-up services to improve long-term cognitive outcomes in high-risk children.
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