Approximately 23,700 children in the U.S. undergo invasive mechanical ventilation for acute respiratory failure annually. Although most survive, little is known if they have worse long-term neurocognitive function than children who do not undergo such procedures. There are concerns about neurotoxic effects of critical illness and its treatment on the developing brain. Therefore, infants and young children may be uniquely susceptible to adverse neurocognitive outcomes after invasive mechanical ventilation.
A four-year sibling-matched cohort study conducted at 31 U.S. PICUs and associated neuropsychology testing centers sheds light on the subject. Researchers found that children who survived PICU hospitalization for respiratory failure and were discharged without severe cognitive dysfunction had significantly lower subsequent IQ scores than their matched siblings.
“While the difference in IQ scores between patients and unexposed siblings was small, the data provide strong evidence of the existence and epidemiology of pediatric post-intensive care syndrome (PICS-p) after a single typical episode of acute respiratory failure necessitating invasive ventilation among generally healthy children,” says Martha A.Q. Curley, PhD, RN, FAAN, Professor of Nursing at the University of Pennsylvania School of Nursing (Penn Nursing) and the study’s lead researcher.
The study reaffirms the importance of assessing long-term outcomes as part of any trial evaluating acute interventions in pediatric critical care. It also underscores the importance of further study to understand which children may be at highest risk, what modifiable factors could cause it, and how it can be prevented. The results of the study have been published in JAMA. The article “Association of Acute Respiratory Failure in Early Childhood With Long-Term Neurocognitive Outcomes” is available online.
Co-authors of the article include R. Scott Watson, MD, MPH, of the University of Washington, Seattle; Lisa A. Asaro, MS, of Boston Children’s Hospital; Cheryl Burns, MS, University of Pittsburgh Medical Center; David Wypij, PhD and Min Jung Koh, MS. both of the Harvard T.H. Chan School of Public Health; Mallory A. Perry, RN, PhD, the Children’s Hospital of Philadelphia; and Sue R. Beers, PhD and Derek C. Angus, MD. MPH, the University of Pittsburgh School of Medicine. Funding for the study included grants from the Eunice Kennedy Shriver National Institute of Child Health and Human Development for RESTORE-Cognition (RO1 HD074757; MPI: Curley and Watson) and for the RESTORE trial from the National Heart, Lung and Blood Institute and the National Institute of Nursing Research, National Institutes of Health (U01 HL086622; Curley and U01 HL086649; Wypij).