PICU Admission and Neurocognitive Outcomes

USA: When compared to matched siblings, survival of pediatric intensive care unit (PICU) admission for respiratory failure and discharge without severe cognitive impairment was linked with considerably lower later IQ scores in children, says an article published in the Journal of American Medical Association.

Every year, about 23,700 children in the United States are subjected to invasive mechanical ventilation for acute respiratory failure, with uncertain long-term repercussions on neurocognitive function. As a result, R. Scott Watson and colleagues undertook this study to compare the neurocognitive results of children who survive PICU admission for acute respiratory failure to those of their biological siblings.

A prospective sibling-matched cohort research was carried out at 31 US PICUs and related neuropsychology testing institutions. Patients had to be 8 years old or younger, with a Pediatric Cerebral Performance Category score of 1 (normal) before PICU admission and less than or equal to 3 at PICU release, eliminating patients with a history of neurocognitive abnormalities or who were readmitted and required mechanical ventilation. Biological siblings ranged in age from four to sixteen years old at the time of testing, with a Pediatric Cerebral Performance Category score of one and no history of mechanical ventilation or general anesthesia. From September 2, 2014, until December 13, 2017, 121 sibling pairs were recruited and began neuropsychological testing on March 14, 2015. The last follow-up was scheduled on November 6, 2018. PICU treatment for acute respiratory failure and critical illness were seen in the participants.

The primary outcome was IQ, as measured by the Wechsler Intelligence Scale's age-appropriate Vocabulary and Block Design subtests. Measures of attention, learning and memory, processing speed, visuospatial skills, language, motor skills, and executive function were among the secondary results. The evaluations were placed between 3 and 8 years after the patient was discharged from the hospital.

Key Findings

• Patients were admitted to the PICU at a median (IQR) age of 1.0 (0.2-3.2) years, had invasive mechanical ventilation for a median (IQR) of 5.5 (3.1-7.7) days, and were tested at a median (IQR) age of 6.6 (5.4-9.1) years.
• At a median (IQR) age of 8.4 (7.0-10.2) years, matched siblings were tested.
• Patients had a lower estimated IQ on average than matched siblings.
• Patients exhibited considerably lower scores on nonverbal memory, visuospatial abilities, and fine motor control than matched siblings, but significantly better scores on processing speed.
• The remaining secondary outcomes, such as attention, expressive language, verbal memory, and executive function, revealed no significant changes.

In conclusion, findings of this study were based on a small magnitude of difference and unknown clinical complication. Further in-depth study is needed to come to solid evidence.

Reference

Watson RS, Beers SR, Asaro LA, et al. Association of Acute Respiratory Failure in Early Childhood With Long-term Neurocognitive Outcomes. JAMA. 2022;327(9):836–845. doi:10.1001/jama.2022.1480