Survivors of septic shock caused by Neisseria meningitidis in childhood: Psychosocial outcomes in young adulthood

Vermunt, Lindy; Buysse, Corinne; Joosten, Koen; Duivenvoorden, Hugo J.; Hazelzet, Jan A.; Verhulst, Frank C.; Utens, Elisabeth M. W. J.

doi:10.1097/pcc.0b013e3182192d7f

Cited by 26 publications

(34 citation statements)

References 38 publications

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“…These findings are important in the context of previous literature. The finding of the association between sepsis and adverse neurocognitive outcomes on multivariable analyses is consistent with the adult literature [1][2][3][4] and strengthens the existing pediatric literature [5][6][7][8][9] by using a large sample size in a prospective inception cohort (n=396 survivors), a high rate of follow-up (96% of survivors followed to 4.5 years of age), a detailed neurocognitive assessment done with validated standardized testing, [13][14][15][16] and adjustment for many potentially confounding variables. That sepsis is a potentially modifiable predictor of adverse outcomes is supported by literature on the prevention of sepsis in the critical care environment.…”

Section: Discussionsupporting

confidence: 85%

“…Similar results in adults have been found by others . In children, limited data suggest that similar adverse neurocognitive outcomes may occur; however, the available pediatric studies have limitations, including small sample sizes, low rates of follow‐up, short periods of follow‐up, lack of detailed neurocognitive testing, and lack of critically ill control groups …”

Section: Introductionsupporting

confidence: 81%

“…We hypothesized that sepsis and ECMO would be associated with outcomes on multivariable analyses based on previous studies. [1][2][3][4][5][6][7][8][9]20,21 Statistical analyses were performed using SAS version 9.3 (SAS Institute). The primary outcomes for this study were the intelligence quotient (FSIQ, PIQ, VIQ) outcomes in survivors.…”

Section: Statisticsmentioning

confidence: 99%

“…[1][2][3] In children, limited data suggest that similar adverse neurocognitive outcomes may occur [5][6][7][8][9] ; however, the available pediatric studies have limitations, including small sample sizes, low rates of followup, short periods of follow-up, lack of detailed neurocognitive testing, and lack of critically ill control groups. [5][6][7][8][9] Infants who have cardiac surgery for complex congenital heart disease (CHD) also can have adverse neurocognitive outcomes. 10,11 As survival has improved, a focus on these adverse outcomes and their potentially modifiable predictors has become more important.…”

mentioning

confidence: 99%

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Sepsis After Cardiac Surgery Early in Infancy and Adverse 4.5‐Year Neurocognitive Outcomes

Sidhu

Joffe

Doughty

et al. 2015

JAHA

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BackgroundWe aimed to determine whether sepsis is associated with neurocognitive outcomes 4.5 years after congenital heart disease surgery in early infancy.Methods and ResultsA secondary analysis from a prospective inception cohort included all children having congenital heart disease surgery done at ≤6 weeks of age with cardiopulmonary bypass at the Western Canadian referral center from 1996 to 2009. Follow-up at the referral center determined the primary outcomes at 4.5 years with full-scale, performance, and verbal intelligence quotients on the Wechsler Preschool and Primary Scale of Intelligence. Perioperative variables were collected prospectively, and confirmation of blood culture–positive sepsis was done retrospectively. Multiple linear regression models for neurocognitive outcomes and multiple Cox proportional hazards regression for mortality were determined. Sepsis occurred in 97 of 502 patients (19%) overall and in 76 of 396 survivors (19%) with 4.5-year follow-up. By 4.5 years, there were 91 (18%) deaths, and 396 of 411 survivors (96%) had follow-up completed. Extracorporeal membrane oxygenation was associated with worse scores on all neurocognitive outcomes on multivariable regression; the association between extracorporeal membrane oxygenation and full-scale intelligence quotient had a regression coefficient of −13.6 (95% CI −21.3 to −5.9; P =0.001). Sepsis perioperatively was associated with performance and verbal intelligence quotients, with a trend for full-scale intelligence quotient (P =0.058) on multivariable regression. The regression coefficient for sepsis was strongest for performance intelligence quotient (−5.31; 95% CI −9.84 to −0.78; P =0.022). Sepsis was not but extracorporeal membrane oxygenation was associated with mortality by 4.5 years.ConclusionsPerioperative sepsis and extracorporeal membrane oxygenation were associated with adverse neurocognitive outcomes on multivariable regression. Quality improvement to prevent sepsis has the potential to improve long-term neurocognitive outcomes in infants after surgery for congenital heart disease.

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Section: Discussionsupporting

confidence: 85%

Section: Introductionsupporting

confidence: 81%

Section: Statisticsmentioning

confidence: 99%

mentioning

confidence: 99%

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Sepsis After Cardiac Surgery Early in Infancy and Adverse 4.5‐Year Neurocognitive Outcomes

Sidhu

Joffe

Doughty

et al. 2015

JAHA

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“…Vermunt et al assessed psychological outcome at a mean age of 23 years and at a mean follow-up interval of 13 years. 17 Up to 20% of 58 eligible patients still struggled with behavioral, emotional, and social problems and scored lower during intelligence tests.…”

Section: Pediatric Sepsismentioning

confidence: 99%

Follow-up of Newborns, Infants, and Children with Sepsis

Dahlem¹,

Biggar²

2017

JCS

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Mortality in newborn infants and children with sepsis is high with survival rates of generally more than 50% in recent studies. Longitudinal follow-up studies have the potential to reveal short-term and lifelong physical, mental, and psychological sequelae. Although no comprehensive follow-up research has yet been performed, a small number of follow-up studies have shown that there is a considerable impact on the patients' lives and their families after hospital discharge. Health-related quality of life also seems to be affected; however, it does not correlate with severity of sepsis or handicap per se. Prematurely born infants, who can develop sequelae directly attributable to prematurity and its consequences, suffer differently from sepsis-related lifelong sequelae compared with older children. Fortunately, time may heal some wounds due to the effect of growth in children. In future, large centers should establish structural follow-up programs for clinical and research purposes to learn more about the needs of affected children and their families.

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Assessment of Long-term Psychological Outcomes After Pediatric Intensive Care Unit Admission

Poh

Heng

et al. 2022

JAMA Pediatr

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The pediatric intensive care unit (PICU) exposes children to stressful experiences with potential long-term psychological repercussions. However, current understanding of post-PICU psychological outcomes is incomplete.OBJECTIVE To systematically review and evaluate reported long-term psychological outcomes among children previously admitted to the PICU.DATA SOURCES A systematic search of the Cumulative Index to Nursing and Allied Health Literature, Embase, MEDLINE (PubMed), and PsycINFO was conducted from database inception to June 2021. Search terms included phrases related to intensive care (eg, intensive care units and critical care) and terms for psychological disorders (eg, posttraumatic stress disorder, depressive disorder, conduct disorder, and neurodevelopmental disorder) limited to the pediatric population.STUDY SELECTION This systematic review and meta-analysis included randomized clinical trials and observational studies reporting psychological disorders among children younger than 18 years who were admitted to the PICU with follow-up for at least 3 months. Psychological disorders were defined using the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition). Children were excluded if they were admitted to the PICU for primary brain conditions (eg, traumatic brain injury, meningoencephalitis, and brain tumors) or discharged to the home for palliative care.DATA EXTRACTION AND SYNTHESIS Titles and abstracts were independently screened by 2 reviewers, with data extraction conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) reporting guideline. Data were pooled using a random-effects model during meta-analysis.MAIN OUTCOMES AND MEASURES Age-corrected IQ scores and long-term psychological outcomes measured by scales such as the Child Behavior Checklist (higher scores indicate more behavioral problems) among children admitted to the PICU. RESULTSOf 9193 records identified, 31 independent studies (5 randomized clinical trials and 26 observational studies) involving 7786 children (mean age, 7.3 years [95% CI, years]; 4267 boys [54.8%]; race and ethnicity were not reported by all studies) admitted to the PICU were included. Overall, 1 of 19 children (5.3%) to 14 of 16 children (88.0%) previously admitted to the PICU were reported to have at least 1 psychological disorder. Studies that examined posttraumatic stress disorder reported that 6 of 60 children (10.0%) to 31 of 102 children (30.4%) met the diagnostic criteria for the disorder at 3 to 6 months of follow-up. Compared with healthy children, those admitted to the PICU had lower IQ scores at 1 to 2 years of 89.40 points [95% CI, points] vs 100.70 points [95% CI, 99.43-101.97 points]; P < .001) and 3 to 5 years of follow-up (mean, 88.54 points [95% CI, 83.92-93.16 points] vs 103.18 [95% CI, 100.36-105.99 points]; P < .001) and greater total emotional and behavioral problems at 4 years of follow-up (mean, 51.69 points [95% CI, 50.37-53.01 points] vs 46.66 points [95% CI, points]; P < .001).CONC...

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Survivors of septic shock caused by Neisseria meningitidis in childhood: Psychosocial outcomes in young adulthood

Cited by 26 publications

References 38 publications

Sepsis After Cardiac Surgery Early in Infancy and Adverse 4.5‐Year Neurocognitive Outcomes

Sepsis After Cardiac Surgery Early in Infancy and Adverse 4.5‐Year Neurocognitive Outcomes

Follow-up of Newborns, Infants, and Children with Sepsis

Assessment of Long-term Psychological Outcomes After Pediatric Intensive Care Unit Admission

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