Related Experiment Video
Updated: Jul 2, 2026
Comparing Eye-tracking Data of Children with High-functioning ASD, Comorbid ADHD, and of a Control Watching Social Videos
Published on: December 7, 2018
Delirium Associated with COVID-19 in Critically ill Children: An Observational Cohort Study
Meghan C Gray1, Chani Traube2, Taylor B Sewell1
1Division of Pediatric Critical Care & Hospital Medicine, Columbia University Irving Medical Center, New York, NY, USA.
Insights
Delirium is common in critically ill children with COVID-19, particularly those on invasive mechanical ventilation. Focus on developmental disability and minimizing risks during ventilation for delirium reduction.
Area of Science:
- Pediatric critical care medicine
- Infectious diseases
- Neuroscience
Background:
- Delirium is under-recognized in critically ill children.
- COVID-19 is associated with delirium in adults, but pediatric data are lacking.
- Multisystem inflammatory syndrome in children (MIS-C) involves hyperinflammation, potentially increasing delirium risk.
Purpose of the Study:
- To characterize delirium in critically ill children with COVID-19.
- To investigate demographic, disease, and treatment factors associated with pediatric delirium.
- To test the hypothesis that MIS-C is linked to higher delirium incidence.
Main Methods:
- Retrospective, single-center cohort study.
- Included 149 pediatric intensive care unit (PICU) hospitalizations with SARS-CoV-2 infection (March 2020-March 2023).
- Categorized patients by COVID-19 respiratory disease, MIS-C, or other primary reasons; assessed delirium incidence and risk factors.
Main Results:
- Delirium occurred in 43% of patients; highest incidence in those requiring invasive mechanical ventilation (IMV) (56%).
- Opioid, dexmedetomidine, paralytic, and benzodiazepine exposure correlated with delirium.
- Multivariable analysis linked delirium to IMV, female sex, and developmental disability.
Conclusions:
- Delirium is prevalent in pediatric COVID-19 patients, though less common than in adults.
- Delirium reduction strategies should target children with developmental disabilities.
- Minimizing risks associated with IMV is crucial for preventing delirium in this population.
Objective:
Delirium is an under-recognized problem in critically ill children. Although delirium is common in adults hospitalized with COVID-19, the relationship between pediatric COVID-19 and delirium has not been described. To address this gap, we characterized delirium in critically ill children with different manifestations of COVID-19 and investigated associations among demographic, disease, and treatment factors. We hypothesized that multisystem inflammatory syndrome in children (MIS-C) would be associated with a higher incidence of delirium given its underlying pathophysiology of hyperinflammation.
Design:
Retrospective, single-center cohort study.
Setting:
Quaternary-care pediatric intensive care unit (PICU).
Patients:
Children less than 18 years of age hospitalized in the PICU between March 2020 and March 2023 with either active SARS-CoV-2 infection or serological evidence of prior infection.
Measurements And Main Results:
The cohort included 149 PICU hospitalizations among children with evidence of COVID-19. Patients were categorized by reason for PICU admission: 75 (50%) for COVID-19 respiratory disease, 36 (24%) MIS-C, and 38 (26%) any other primary reason with positive COVID-19 testing. Delirium was diagnosed in 43 (29%) patients. Delirium incidence was highest in patients requiring invasive mechanical ventilation (IMV) (56% vs 7.5% in patients who did not require IMV, p < .001). Patients who were exposed to opioids, dexmedetomidine, paralytics or benzodiazepines more frequently experienced delirium compared to those unexposed (p < .001, p < .001, p < .001 and p = .001, respectively). After multivariable adjustment, delirium was associated with IMV (HR 3 [95% CI 1.5-5.7]), female sex (HR 2.4 [1.2-4.7]), and developmental disability (HR 3.4 [95% CI 1-11.1]). There was no association between delirium and reason for PICU hospitalization.
Conclusions:
Delirium was common among children hospitalized with COVID-19. The overall incidence was much less than has been reported in adults with COVID-19. Delirium reduction efforts should focus on children with developmental disability and minimizing ongoing risks during IMV.
More Related Videos
Related Concept Videos
01:30Pneumonia III: Complications and Assessment
01:29Respiratory Syncytial Virus Disease