For a study, researchers sought to compare the neurocognitive results of children who survive PICU hospitalization for acute respiratory failure to those of their biological siblings. Prospective sibling-matched cohort research was undertaken at 31 PICUs in the United States and affiliated neuropsychology testing institutes. Patients were 8 years or younger with a Pediatric Cerebral Performance Category score of 1 (normal) prior to PICU admission and less than or equal to 3 (no worse than moderate neurocognitive dysfunction) at PICU discharge, excluding patients with a history of neurocognitive deficits or who were readmitted and required mechanical ventilation. At the time of testing, biological siblings ranged in age from 4 to 16 years old, had a Pediatric Cerebral Performance Category score of 1, and had no history of mechanical breathing 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 for November 6, 2018. Acute respiratory failure necessitated critical illness and PICU care. The primary outcome was IQ, as measured by the Wechsler Intelligence Scale’s age-appropriate Vocabulary and Block Design subtests. Measures of attention, processing speed, learning and memory, visuospatial skills, motor skills, language, 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.
Patients (n = 121; 55 [45%] female 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 (n = 121; 72 [60%] female siblings) were tested. Patients’ mean estimated IQ was lower than that of matched siblings (101.5 vs 104.3; mean difference, –2.8 [95% CI, –5.4 to –0.2]). Patients had significantly lower scores on nonverbal memory (mean difference, –0.9 [95% CI, –1.6 to –0.3]), visuospatial skills (mean difference, –0.9 [95% CI, –1.8 to –0.1]), and fine motor control (mean difference, –3.1 [95% CI, –4.9 to –1.4]) than matched siblings, but significantly higher scores on processing speed (mean difference, 4.4 [95% CI, 0.2-8.5]). The remaining secondary outcomes, such as attention, verbal memory, expressive language, and executive function, revealed no significant changes.
When compared to matched siblings, survival of PICU hospitalization for respiratory failure and discharge without severe cognitive impairment was linked with significantly lower later IQ scores in children. The amount of the change, however, was minor and of unknown clinical significance.
Reference:jamanetwork.com/journals/jama/article-abstract/2789542
