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Updated: May 24, 2026

Assessment and Evaluation of the High Risk Neonate: The NICU Network Neurobehavioral Scale
19:15

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Published on: August 25, 2014

Risk Factors for Delirium in Pediatric Intensive Care Units: A Systematic Review and Meta-Analysis

Zhiwen Zhang1, Peng Zhou1

  • 1Department of Pediatric, Shengzhou People's Hospital, Shengzhou Branch of the First Affiliated Hospital of Zhejiang University School of Medicine, The Shengzhou Hospital of Shaoxing University, Shaoxing City, Zhejiang Province, China.

Pediatric Neurology
|May 22, 2026
PubMed

Insights

Pediatric intensive care unit (PICU) delirium is linked to many risk factors. Younger age, ventilation, and certain medications increase delirium risk in critically ill children.

Area of Science:

  • Pediatric Critical Care Medicine
  • Neuroscience
  • Pharmacology

Background:

  • Delirium is a common and severe complication in pediatric intensive care units (PICUs).
  • Identifying risk factors for pediatric delirium is crucial for improving patient outcomes.
  • This study systematically reviews and quantifies these risk factors.

Purpose of the Study:

  • To systematically review and quantify risk factors associated with delirium in critically ill children admitted to PICUs.
  • To identify both modifiable and nonmodifiable factors contributing to pediatric delirium.

Main Methods:

  • Comprehensive literature searches were performed across major databases (PubMed, Embase, Web of Science, Scopus) up to November 2025.
  • Included observational studies reporting delirium in PICU settings.
  • Univariate odds ratios were pooled using DerSimonian-Laird random-effects models for meta-analysis.

Main Results:

  • Thirty-four studies involving 23 risk factors were meta-analyzed.
  • Significant predictors included younger age, developmental delay, neurological disorders, mechanical ventilation (prolonged and noninvasive), and exposure to multiple medications (benzodiazepines, opioids, dexmedetomidine, antiepileptics, corticosteroids).
  • Vasoactive support, cyanotic heart disease, blood transfusions, physical restraints, and longer PICU stays were also significant risk factors.

Conclusions:

  • Multiple modifiable and nonmodifiable factors contribute to delirium in critically ill children.
  • Key risk factors identified include ventilation, specific medications, and longer hospital stays.
  • Limitations include the use of univariate data and significant heterogeneity, impacting the certainty of conclusions.
Abstract

Keywords:
ChildrenCritical careDeliriumMeta-analysisRisk

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