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Mechanical Ventilation Boot Camp Curriculum
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Virtual Developmental Screening After Invasive Mechanical Ventilation in Children: A Prospective Cohort Pilot Study
Nicholas J Bartel1, David W Boyle2, Abbey C Hines2
1Department of Pediatrics, Indiana University Schoolof Medicine, Indianapolis, IN.
Insights
Virtual follow-up effectively screens children for developmental delays after pediatric intensive care unit (PICU) stays. This approach facilitates early intervention, though resource limitations for some families require attention.
Area of Science:
- Pediatric critical care medicine
- Neurodevelopmental outcomes
- Healthcare technology
Background:
- Decreasing mortality in pediatric intensive care units (PICUs) has led to an increase in survivor morbidity.
- Post-intensive care syndrome (PICS) presents significant challenges for long-term child development.
- Effective follow-up strategies are needed to address neurodevelopmental deficits in young children after PICU discharge.
Purpose of the Study:
- To evaluate the feasibility of a virtual PICU-led follow-up program.
- To screen at-risk children for neurodevelopmental abnormalities post-PICU.
- To facilitate early developmental intervention for identified cases.
Main Methods:
- Prospective cohort study at a single quaternary children's hospital.
- Inclusion of children aged 4 years or younger requiring mechanical ventilation.
- Web-based administration of Ages and Stages Questionnaires, Third Edition (ASQ-3) at 3, 6, and 12 months post-discharge.
Main Results:
- 48 patients enrolled; 58% completed at least one ASQ-3.
- Lower caregiver education, income, and single-caregiver status correlated with lower completion rates.
- 50% of completers flagged as at-risk for developmental delay, leading to early intervention referrals.
Conclusions:
- Virtual, caregiver-completed surveillance is a feasible method for screening neurodevelopmental issues in children post-PICU.
- This approach aids in timely referral for developmental interventions.
- Targeted support is crucial for families facing resource limitations to ensure successful follow-up.
Objectives:
With decreasing PICU mortality, survivor morbidity has increased. This study aims to evaluate feasibility of virtual PICU-led follow-up of patients at risk for pediatric postintensive care syndrome.
Design:
Prospective cohort study.
Setting:
Single-center, quaternary children's hospital.
Patients:
Children less than or equal to 4 years without known preexisting neurodevelopmental deficits requiring greater than or equal to 12 hours mechanical ventilation.
Interventions:
None.
Measurements And Main Results:
Age-appropriate Ages and Stages Questionnaires, Third Edition (ASQ-3) were administered via a web-based system at 3, 6, and 12 months following PICU discharge. Primary-care physicians were notified of results; at-risk patients were referred to early developmental intervention. Forty-eight patients enrolled with median age 11.5 months (interquartile range [IQR], 2-19.5 mo) and median mechanical ventilation duration 92.5 hours (IQR, 40.5-147 hr). Fifty-eight percent completed greater than or equal to 1 ASQ-3. Lower caregiver educational achievement, lower income, and single-caregiver status were associated with lower ASQ-3 completion rates. Of those completing any ASQ-3, 50% flagged as at-risk for developmental delay and referred to early developmental intervention. There was no association between patient characteristics and abnormal ASQ-3.
Conclusions:
Virtual caregiver-completed surveillance is a promising method to screen children for neurodevelopmental abnormalities following PICU hospitalization and facilitate early referral for developmental intervention, but special attention must be dedicated to families with limited resources for follow-up.
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