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Risk of Neuropsychiatric Disorders After Pediatric Delirium in Children Under 12: A Cohort Study
Ching-Fang Sun1,2, Chih-Sung Liang3, Yingxing Wu4
1Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA, USA.
Insights
Pediatric delirium significantly increases the risk of major neuropsychiatric disorders in children. Early recognition and long-term follow-up are crucial for managing these long-term consequences.
Area of Science:
- Neuroscience
- Pediatrics
- Psychiatry
Background:
- Delirium in adults is linked to long-term neuropsychiatric issues.
- The impact of pediatric delirium on future mental health remains understudied.
Purpose of the Study:
- To investigate the long-term risk of major neuropsychiatric disorders following pediatric delirium.
- To compare the incidence of these disorders in children with and without a history of delirium.
Main Methods:
- Analysis of de-identified electronic health records from the TriNetX Research network (2013-2023).
- Inclusion of pediatric patients (<12 years) with and without delirium, matched for demographics and physical comorbidities.
- Application of Cox regression and Kaplan-Meier analysis to assess neuropsychiatric disorder risk.
Main Results:
- Pediatric delirium was associated with a 2.15-fold higher risk of neuropsychiatric disorders.
- 5-year freedom from disorders was 68.5% in the delirium group versus 49.8% in controls.
- Younger children (≤6 years) with delirium showed higher risks for externalizing disorders, intellectual disability, and ADHD.
Conclusions:
- Children experiencing delirium face a significantly elevated risk of developing major neuropsychiatric disorders.
- Healthcare providers should monitor for early signs of neuropsychiatric conditions in pediatric delirium survivors.
- Awareness and long-term surveillance are essential for managing these risks.
Objective:
Delirium is known to be related to neuropsychiatric comorbidities as long-term consequences in adult patients. However, the risk of major neuropsychiatric disorders after pediatric delirium remains largely unexplored.
Methods:
We analyzed de-identified electronic health records (2013 to 2023) from the TriNetX Research network, a network with more than 111 million patients. Patients under age 12 years with delirium and a control group without delirium were identified and matched by age, sex, race, ethnicity, and physical comorbidities at a one-to-four ratio. We applied Cox regression and Kaplan-Meier analysis to assess the risk of neuropsychiatric disorders.
Results:
A total of 618 pediatric patients with delirium were included, demonstrating a 2.15-fold higher risk of neuropsychiatric disorders than controls without delirium (hazard ratio [HR] with 95% confidence interval [CI]: 2.15, 1.82-2.56). The 5-year freedom from these disorders was 68.5% (95% CI, 65.5-71.8) in the study cohort, whereas it was 49.8% (95% CI, 44.1-56.2) in the control cohort. Subgroup analysis showed that children aged 6 years or younger were more likely to be diagnosed with externalizing disorder, including substance use disorder (HR=4.34; 95% CI, 2.00-9.44; p<0.001), intellectual disability (HR=1.71; 95% CI, 1.27-2.30; p<0.001), and attention-deficit/hyperactivity disorder (HR=2.25; 95% CI, 1.16-4.34; p=0.02).
Conclusion:
Pediatric patients with delirium are at increased risk of major neuropsychiatric disorders compared to their control counterparts without delirium. Clinicians need to be aware of early symptoms and signs suggesting major neuropsychiatric disorders during the long-term follow-up period.
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