Source:

Als
LC
,
Nadel
S
,
Cooper
M
, et al
.
Neuropsychologic function three to six months following admission to the PICU with meningoencephalitis, sepsis, and other disorders: a prospective study of school-aged children
.
Crit Care Med.
2013
;
41
(
4
):
1094
1103
; doi:
https://doi.org/10.1097/CCM.0b013e318275d032

Investigators from multiple institutions in the United Kingdom sought to determine whether children admitted to the PICU have neurocognitive functioning comparable to healthy controls 3 to 6 months following discharge. Children were eligible if they were 5 to 16 years old and admitted to one of 2 UK PICUs from 2007 to 2010. Children were excluded if they presented with a condition that likely had an effect on neuropsychological function (other than meningoencephalitis [ME] or sepsis) or had pre-existing neurologic disabilities, neurologic injury, or psychiatric disorders. Cases were categorized into 3 subgroups based on their diagnosis: ME, sepsis, or non-neurologic, non-septic (NNNS) critical illness. Healthy controls were enrolled from local schools or from the families of cases.

The primary outcome of interest was neuropsychological function at 3 and 6 months following discharge. This was assessed in both cases and controls by administering a battery of neuropsychological tests, including IQ, memory, and attention. A secondary outcome was academic performance, which was assessed using a teacher-completed questionnaire. Sociodemographic characteristics, medical history, and history of prior emotional and behavior problems were also collected from all participants. The clinical history of cases was abstracted from medical records.

Of 647 age-eligible survivors after PICU admission during the enrollment period, 88 were enrolled (14%). Of these, 21 had ME, 22 had sepsis, and 45 had NNNS critical illness. There were 100 controls enrolled.

Compared to controls, the only neuropsychological test in which all 3 PICU case groups performed significantly worse was IQ (95, 98, and 100 for the ME, sepsis, and NNNS groups, respectively, vs 107 for controls). In all other neuropsychological tests, the NNNS group performance was not significantly different from controls. The ME and sepsis groups, however, performed significantly worse on measures of verbal and visual recall, memory, and visual sustained attention. There were no significant differences between controls and the NNNS cases on academic performance. ME and sepsis cases showed significantly higher rates of difficulties in completing school work compared to controls, and sepsis cases also had significantly higher rates of decline in academic performance. The presence of seizures during admission, age, and low socioeconomic status were found to be significant predictors of poor neuropsychological function among ME and sepsis cases compared to NNNS cases.

The authors conclude that there are neuropsychological deficits in school-age children 3 to 6 months after admission to the PICU, with the most pronounced occurring in those with ME and sepsis among those studied.

Dr Bratton has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.

This report raises several questions. First, the 3 groups who received intensive care were...

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