Delirium and Cognitive Dysfunction in and Beyond the Pediatric Intensive Care Unit

The literature shows a high incidence of delirium in the pediatric intensive care unit (PICU). Children have high rates of cognitive dysfunction following PICU admission. Delirium has been linked to declines in academic performance. The primary objective of this investigation was to examine the incidence of delirium in children admitted to the PICU and the relationship between delirium and long-term cognitive dysfunction.

Observational.

Urban, academic, children's hospital PICU.

Children aged 5-17 years with expected PICU stay >24 hours.

None.

Delirium screening was conducted daily during PICU admission. Children's memory was assessed using the Children's Memory Scale during hospitalization and at 3-month follow-up. Parents completed the Behavior Rating Inventory of Executive Function-2 during admission (reflecting prehospital executive functioning) and at follow-up. A total of 146 children were enrolled. A subset of 103 completed in-hospital and/or 3-month Children's Memory Scale (mean age = 11.0 years). Approximately one-third of children demonstrated cognitive dysfunction at 3 months. During admission, 37.3% of children screened positive for delirium, but results demonstrated no relation between delirium burden and cognitive dysfunction at either time point. However, children exhibited sustained deficits from hospitalization to follow-up.

The current investigation is a novel evaluation of the influence of pediatric delirium on later cognitive function. Children admitted to the PICU demonstrated high rates of cognitive dysfunction during hospitalization and at 3-month follow-up. While in-hospital cognitive dysfunction was associated with later cognitive dysfunction, delirium burden was not associated with cognitive dysfunction at either time point.