Neurocognitive functioning and health-related quality of life of children after pediatric intensive care admission: a systematic review

Abstract

Objective This study systematically reviewed recent findings on neurocognitive functioning and health-related quality of life (HRQoL) of children after pediatric intensive care unit admission (PICU). Data sources Electronic databases searched included Embase, Medline Ovid, Web of Science, Cochrane CENTRAL, and Google Scholar. The search was limited to studies published in the last five years (2015–2019). Study selection Original studies assessing neurocognitive functioning or HRQoL in children who were previously admitted to the PICU were included in this systematic review. Data extraction Of the 3649 identified studies, 299 met the inclusion criteria based on title abstract screening. After full-text screening, 75 articles were included in the qualitative data reviewing: 38 on neurocognitive functioning, 33 on HRQoL, and 4 on both outcomes. Data synthesis Studies examining neurocognitive functioning found overall worse scores for general intellectual functioning, attention, processing speed, memory, and executive functioning. Studies investigating HRQoL found overall worse scores for both physical and psychosocial HRQoL. On the short term (≤ 12 months), most studies reported HRQoL impairments, whereas in some long-term studies HRQoL normalized. The effectiveness of the few intervention studies during and after PICU admission on long-term outcomes varied. Conclusions PICU survivors have lower scores for neurocognitive functioning and HRQoL than children from the general population. A structured follow-up program after a PICU admission is needed to identify those children and parents who are at risk. However, more research is needed into testing interventions in randomized controlled trials aiming on preventing or improving impairments in critically ill children during and after PICU admission.

Neurocognitive, Psychosocial, and Quality of Life Outcomes After Multisystem Inflammatory Syndrome in Children Admitted to the PICU*

“…In this study, the objectively tested general intelligence and verbal memory outcomes in children with MIS-C were comparable with the Dutch normative data. Interestingly, these age-adequate full scale intelligence scores in children with MIS-C contrast with the lower intelligence scores reported in recent meta-analyses in the general PICU population (14)(15)(16). We also found that the parent-reported executive function scores (BRIEF questionnaire) were comparable with the general Dutch population, which, again, contrasts with the previously reported worse parent-reported executive functions in the general PICU population ( 17).…”

“…An explanation for the current MIS-C cohort with better overall cognitive function might be the short length of stay in the PICU during acute illness. In the general PICU population, prolonged length of stay on the PICU is associated with worse cognitive functioning ( 14 , 16 ).…”

“…In accordance with general PICU population studies, at follow-up, children with MIS-C had worse physical QoL than general population norm. In the general PICU population, lower physical QoL has been associated with older age, longer length of stay on the PICU, and increased disease severity ( 14 , 15 ). Regarding children with MIS-C, the length of PICU stay was short, and as reported in other cohort studies, the cardiac function normalized in most MIS-C patients ( 4 , 6 ).…”

Post-PICU Cognitive and Psychological Outcomes in Children Receiving Treatments for Acute Lymphoblastic Leukemia

“…Children surviving PICU often experience a constellation of post-PICU long-term cognitive, psychological, and physical impairments, commonly referred to as post-intensive care syndrome—pediatric (PICS-p) (1–3). Pediatric survivors of critical care are at risk for cognitive impairments and psychological problems that negatively impact their daily functioning and quality of life (4–10). Risk factors and mechanisms underlying neurocognitive and psychological outcomes are not yet well understood but may be related to delirium, mechanical ventilation, sepsis, sedation/analgesic medications, length of ICU admission, severity of illness, severe respiratory failure/hypoxia, and inflammation (11–14).…”

“…Although still emerging, the literature indicating cognitive impairments following pediatric critical illness is growing (5–7, 10, 14–16). Various risk factors have been associated with acquiring functional or cognitive impairments following a PICU admission, including a trauma, oncologic or neurologic diagnosis, longer length of PICU stay, higher risk of mortality, invasive mechanical ventilation, renal replacement therapy, cardiopulmonary resuscitation, and extracorporeal membrane oxygenation (13, 17).…”