Online Review Article

A Systematic Review of Risk Factors Associated With Cognitive Impairment After Pediatric Critical Illness*

Kachmar, Alicia G. RN, BA, BSN^1,2; Irving, Sharon Y. PhD, CRNP, FCCM, FAAN^1,3; Connolly, Cynthia A. PhD, RN, FAAN¹; Curley, Martha A. Q. RN, PhD, FAAN^1,4,5

Author Information

¹Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia, PA.

²Hillman Scholars Program in Nursing Innovation at the University of Pennsylvania School of Nursing, Philadelphia, PA.

³Division of Anesthesiology and Critical Care Medicine, Critical Care Nursing, Children’s Hospital of Philadelphia, Philadelphia, PA.

⁴Division of Anesthesia and Critical Care Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.

⁵Critical Care and Cardiovascular Program, Boston Children’s Hospital, Boston, MA.

*See also p. 277.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s website (http://journals.lww.com/pccmjournal).

Supported, in part, by the Rita and Alex Hillman Foundation (to Ms. Kachmar)

Ms. Kachmar received funding from the Rita and Alex Hillman Foundation (this funding was not specifically for the research or writing associated with this article; however, she researched and wrote during the academic year when she received Hillman funding). Dr. Irving received funding from Nutricia and the American Society for Parenteral and Enteral Nutrition. The remaining authors have disclosed that they do not have any potential conflicts of interest.

For information regarding this article, E-mail: [email protected]

Pediatric Critical Care Medicine 19(3):p e164-e171, March 2018. | DOI: 10.1097/PCC.0000000000001430

Abstract

Objectives:

To identify risk factors associated with cognitive impairment as assessed by neuropsychologic tests in neurotypical children after critical illness.

Data Sources:

For this systematic review, we searched the Cochrane Library, Scopus, PubMed, Ovid, Embase, and CINAHL databases from January 1960 to March 2017.

Study Selection:

Included were studies with subjects 3–18 years old at the time of post PICU follow-up evaluation and use of an objective standardized neuropsychologic test with at least one cognitive functioning dimension. Excluded were studies featuring patients with a history of cardiac arrest, traumatic brain injury, or genetic anomalies associated with neurocognitive impairment.

Data Extraction:

Twelve studies met the sampling criteria and were rated using the Newcastle-Ottawa Quality Assessment Scale.

Data Synthesis:

Ten studies reported significantly lower scores in at least one cognitive domain as compared to healthy controls or normed population data; seven of these—four case-control and three prospective cohort studies—reported significant lower scores in more than one cognitive domain. Risk factors associated with post critical illness cognitive impairment included younger age at critical illness and/or older age at follow-up, low socioeconomic status, high oxygen requirements, and use of mechanical ventilation, sedation, and pain medications.

Conclusions:

Identifying risk factors for poor cognitive outcomes post critical illness may help healthcare teams modify patient risk and/or provide follow-up services to improve long-term cognitive outcomes in high-risk children.

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A Systematic Review of Risk Factors Associated With Cognitive Impairment After Pediatric Critical Illness*