Post-intensive care sequelae after severe bacterial infections in previously healthy children

Severe complications of common community-acquired infections can necessitate pediatric intensive care even in previously healthy children. While survival after pediatric intensive care has improved, data on long-term physical, cognitive, and psychosocial outcomes in this population remain limited. This study evaluated 12-month outcomes in previously healthy children admitted to the pediatric intensive care unit for severe infectious complications and describes the implementation of a structured post-intensive care follow-up program at a tertiary care center in Germany.

We conducted a retrospective single-center study including previously healthy children admitted to the PICU in 2023 due to severe complications of community-acquired infections. Patients participated in a structured multidisciplinary follow-up program with standardized neurological, physical, cognitive, and psychosocial assessments performed up to 12 months after discharge.

Thirty-seven previously healthy children admitted in 2023 were included. The largest subgroup of the study population consisted of children with intracranial abscess or meningitis (43%), orbital abscess (27%), septic shock (14%), osteomyelitis (11%), and necrotizing fasciitis (5%). Despite appropriate acute management and survival of all patients, 25 children (68%) developed persistent neurological, somatic, or psychosocial impairments during follow-up. Common sequelae included motor deficits, neurocognitive dysfunction, sensory impairment, anxiety, and reduced physical endurance. Importantly, many complications were not apparent early after discharge and emerged several months later, with a median time to identification of approximately five months. Recovery trajectories varied considerably, reflecting the multidimensional nature of pediatric post-intensive care morbidity.

A substantial proportion of previously healthy children experience clinically relevant, multidimensional morbidity after severe infections requiring intensive care. These findings highlight the importance of structured, multidisciplinary post-intensive care follow-up to enable early recognition of delayed sequelae and timely intervention, with the potential to reduce long-term morbidity and improve quality of life for affected children and their families.