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Neurodevelopmental and behavioural disorders after perioperative invasive mechanical ventilation in paediatric
Oliver G Isik1, Ling Guo1, Ariel Ben-Ezra1
1Department of Anesthesiology, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA.
Insights
Children needing invasive mechanical ventilation (IMV) during surgery face higher risks of neurodevelopmental and behavioral disorders (NDBD). Prolonged IMV, especially over 96 hours, significantly increases these risks post-discharge.
Area of Science:
- Pediatric critical care medicine
- Neurodevelopmental disorders
- Surgical outcomes
Background:
- Children requiring invasive mechanical ventilation (IMV) in the pediatric intensive care unit (PICU) are at higher risk for neurodevelopmental and behavioral disorders (NDBD).
- This study specifically investigates NDBD in children undergoing surgical admissions and receiving IMV.
Purpose of the Study:
- To evaluate the risk of post-discharge neurodevelopmental and behavioral disorders (NDBD) in children who received invasive mechanical ventilation (IMV) during a surgical admission.
- To analyze the association between the duration of IMV and the risk of NDBD.
- To examine the relationship between post-discharge psychotropic medication use and IMV exposure.
Main Methods:
- A retrospective cohort study using Texas Medicaid data from 1999-2012.
- Identified children with surgical admissions, categorizing them into PICU with IMV, PICU without IMV, and intermediate medical care unit (IMCU) groups.
- Matched these groups to children admitted to general wards and analyzed post-discharge NDBD rates, IMV duration, and psychotropic medication use.
Main Results:
- Children receiving IMV during surgical admissions showed significantly higher rates of NDBD (HR 1.91).
- No increased NDBD rates were found in children in the PICU without IMV or in the IMCU.
- Elevated NDBD risk was primarily associated with IMV duration of 96 hours or more, with increased psychotropic medication use observed only in the IMV group.
Conclusions:
- Invasive mechanical ventilation during surgical admissions is linked to an increased risk of neurodevelopmental and behavioral disorders in children post-discharge.
- Further research is necessary to understand the underlying mechanisms and identify potential modifiable risk factors.
- Findings highlight the importance of monitoring neurodevelopmental outcomes in pediatric surgical patients who have undergone IMV.
Background:
Children with a respiratory disease requiring invasive mechanical ventilation (IMV) in the paediatric intensive care unit (PICU) have an elevated risk for subsequent neurodevelopmental and behavioural disorders (NDBD). This study evaluates NDBD in children receiving IMV during surgical admissions.
Methods:
Children enrolled in Texas Medicaid between 1999 and 2012 with a surgical admission were evaluated. Children in the PICU receiving IMV, in the PICU not receiving IMV, and in the intermediate medical care unit (IMCU) were identified and matched to children admitted to the general ward. The primary outcome was post-discharge NDBD. Secondary analyses evaluated NDBD risk by IMV duration and post-discharge psychotropic medication use.
Results:
Of 35 161 children with surgical admissions meeting eligibility criteria, 993 were in the PICU with IMV, 7670 in the PICU without IMV, and 1027 in the IMCU. Increased rates of NDBD were observed in children receiving IMV (hazard ratio [HR] 1.91, 95% confidence interval [CI] 1.27-2.89, P=0.002), but not in those in the PICU without IMV (HR 1.12, 95% CI 0.98-1.29, P=0.10) or IMCU (HR 0.88, 95% CI 0.61-1.26, P=0.48). Elevated rates of NDBD were detected primarily in children receiving IMV for 96 h or more. Increased psychotropic medication use was observed only in the IMV group.
Conclusions:
Children receiving invasive mechanical ventilation during a surgical admission are at increased risk of neurodevelopmental and behavioural disorders after hospital discharge. Further research is needed to clarify the mechanisms behind this association and to identify potentially modifiable risk factors.
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