An 18-year, single centre, retrospective study of long-term neurological outcomes in paediatric submersion-related cardiac arrests
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Denne Scharink1, Maayke Hunfeld1,2, Marijn Albrecht1
1Department of Neonatal and Paediatric Intensive Care, Division of Paediatric Intensive Care, Erasmus MC Sophia Children's Hospital, University Medical Center Rotterdam, Doctor Molewaterplein 40, 3015 GD Rotterdam, the Netherlands.
Insights
Long-term outcomes for children surviving submersion-related cardiac arrests (CA) show favourable neurological status but significant neuropsychological deficits. Standardized follow-up care is crucial for pediatric drowning survivors.
Area of Science:
- Pediatric critical care medicine
- Neurology
- Public health
Background:
- Submersion-related cardiac arrests (CA) in children present significant challenges for long-term survival and recovery.
- Understanding the long-term neurological and cognitive outcomes is essential for guiding patient care and rehabilitation strategies.
Purpose of the Study:
- To investigate the long-term outcomes, including neurological status and neuropsychological functioning, in children who experienced submersion-related cardiac arrests.
- To identify potential deficits and inform the need for structured follow-up protocols.
Main Methods:
- A cohort of children (1 day–17 years) admitted to a pediatric hospital between 2002 and 2019 following drowning with CA were included.
- Primary outcome was survival with favorable neurological outcome (Pediatric Cerebral Performance Category [PCPC] 1-3). Secondary outcomes included age-appropriate neuropsychological assessments.
- Follow-up duration varied, with a median of 2.3 years for neurological status and 4.0 years for neuropsychological assessments.
Main Results:
- Of 99 children included, 40 died in-hospital and 4 post-discharge. Among survivors (n=52), 47 had favorable neurological outcomes (PCPC 1-3).
- Twenty-six children underwent neuropsychological assessments, revealing significantly lower general and performance intelligence scores, processing speed, and visual motor integration compared to normative data.
- These deficits were statistically significant (p < 0.01) across multiple cognitive domains.
Conclusions:
- While many pediatric drowning survivors achieve favorable neurological status, significant long-term neuropsychological deficits persist.
- This highlights the critical need for standardized, long-term follow-up programs as a standard of care for children following submersion-related cardiac arrests.
- Early identification and intervention for cognitive impairments are vital for optimizing recovery and quality of life in this population.
Aim:
Investigate long-term outcome in paediatric submersion-related cardiac arrests (CA).
Methods:
Children (age one day-17 years) were included if admitted to the Erasmus MC Sophia Children's Hospital, after drowning with CA, between 2002 and 2019. Primary outcome was survival with favourable neurological outcome, defined as a Paediatric Cerebral Performance Category (PCPC) score of 1-3 at longest available follow-up. Secondary outcome were age-appropriate neuropsychological assessments at longest available follow-up.
Results:
Upon hospital admission, 99 children were included (median age at time of CA 3.2 years [IQR 2.0-5.9] and 65% males). Forty children died in-hospital (no return of circulation (45%) or withdrawal of life sustaining therapies (55%)) and 4 children deceased after hospital discharge due to complications following the drowning-incident. Among survivors, with a median follow-up of 2.3 years [IQR 0.2-5.5], 47 children had favourable neurological outcome (i.e. PCPC 1-3) and 8 children unfavourable (unfavourable outcome group total n = 52, i.e. PCPC 4-5 or deceased). Twenty-six (47%) children participated in a neuropsychological assessment (median follow-up 4.0 years [IQR 2.3-8.7]). Compared with normative test data, participants obtained worse general (p = 0.008) and performance (p = 0.003) intelligence scores, processing speed (p = 0.002) and visual motor integration scores (p = 0.0012).
Conclusions:
Although overall outcome in survivors was favourable at longest available follow-up, significant deficits in neuropsychological assessments were found. This study underlines the need for a standardized long term follow-up program as standard of care in paediatric drowning with CA.
