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Daughtrey HR, Ruiz MO, Felix N, Saynina O, Sanders LM, Anand KJS. Incidence of mental health conditions following pediatric hospital admissions: analysis of a national database. Front Pediatr 2024; 12:1344870. [PMID: 38450296 PMCID: PMC10915034 DOI: 10.3389/fped.2024.1344870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2023] [Accepted: 02/05/2024] [Indexed: 03/08/2024] Open
Abstract
Introduction Despite increasing survival of children following hospitalization, hospitalization may increase iatrogenic risk for mental health (MH) disorders, including acute stress, post-traumatic stress, anxiety, or depression. Using a population-based retrospective cohort study, we assessed the rates of new MH diagnoses during the 12 months after hospitalization, including the moderating effects of ICU exposure. Study design/methods This was a retrospective case control study using the Truven Health Analytics insurance database. Inclusion criteria included children aged 3-21 years, insurance enrollment for >12 months before and after hospital admission. We excluded children with hospitalization 2 years prior to index hospitalization and those with prior MH diagnoses. We extracted admission type, ICD-10 codes, demographic, clinical, and service coordination variables from the database. We established age- and sex-matched cohorts of non-hospitalized children. The primary outcome was a new MH diagnosis. Multivariable regression methods examined the risk of incident MH disorder(s) between hospitalized and non-hospitalized children. Among hospitalized children, we further assessed effect modification from ICU (vs. non-ICU) stay, admission year, length of stay, medical complexity, and geographic region. Results New MH diagnoses occurred among 19,418 (7%) hospitalized children, 3,336 (8%) ICU-hospitalized children and 28,209 (5%) matched healthy controls. The most common MH diagnoses were anxiety (2.5%), depression (1.9%), and stress/trauma (2.2%) disorders. Hospitalization increased the odds of new MH diagnoses by 12.3% (OR: 1.123, 95% CI: 1.079-1.17) and ICU-hospitalization increased these odds by 63% (OR: 1.63, 95% CI: 1.483-1.79) as compared to matched, non-hospitalized children. Children with non-complex chronic diseases (OR: 2.91, 95% CI: 2.84-2.977) and complex chronic diseases (OR: 5.16, 95% CI: 5.032-5.289) had a substantially higher risk for new MH diagnoses after hospitalization compared to patients with acute illnesses. Conclusion Pediatric hospitalization is associated with higher, long-term risk of new mental health diagnoses, and ICU hospitalization further increases that risk within 12 months of the acute episode. Acute care hospitalization confers iatrogenic risks that warrant long-term mental and behavioral health follow-up.
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Affiliation(s)
- Hannah R. Daughtrey
- Pediatric Cardiac Critical Care Medicine, Children’s National Heart Institute, Washington, DC, United States
- Department of Pediatrics, George Washington University School of Medicine, Washington, DC, United States
| | - Monica O. Ruiz
- Department of Pediatric Critical Care Medicine, The Warren Alpert Medical School, Brown University, Providence, RI, United States
| | - Nicole Felix
- Department of Pediatric Critical Care Medicine, The Warren Alpert Medical School, Brown University, Providence, RI, United States
| | - Olga Saynina
- Department of Pediatrics, Stanford Child Wellness Lab, Maternal & Child Health Research Institute, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Lee M. Sanders
- Department of Pediatrics, Stanford Child Wellness Lab, Maternal & Child Health Research Institute, Stanford University School of Medicine, Palo Alto, CA, United States
- Academic General Pediatrics, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Kanwaljeet J. S. Anand
- Department of Pediatrics, Stanford Child Wellness Lab, Maternal & Child Health Research Institute, Stanford University School of Medicine, Palo Alto, CA, United States
- Pediatric Critical Care Medicine, Stanford Children’s Health, Palo Alto, CA, United States
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Tang M, Zhang H, Liu X, Li N, Sun X, Zhang X. Quality of Life Among Chinese Child Survivors of Heart Failure After Discharge From Pediatric Intensive Care Unit. J Pediatr Health Care 2024; 38:e1-e6. [PMID: 37855782 DOI: 10.1016/j.pedhc.2023.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Revised: 07/24/2023] [Accepted: 09/14/2023] [Indexed: 10/20/2023]
Abstract
INTRODUCTION This study investigated the current quality of life (QOL) status and related influencing factors in children with heart failure in the pediatric intensive care unit (PICU). METHOD One hundred eighty-three children admitted to the PICU with heart failure were consecutively sampled. They were assessed 3 months after discharge and compared with a control group of 160 healthy individuals. The Pediatric Quality of Life Inventory (version 4.0) and Children's Revised Impact of Event Scale were completed, and factors influencing QOL were analyzed. RESULTS Three months after discharge, the PICU group reported lower average scores on the overall QOL and the physical and emotional functioning scales than the control group. In particular, posttraumatic stress disorder status, age, and caregiver educational level greatly influenced the PICU children's QOL. DISCUSSION More interventions and attention are needed to improve the QOL for PICU heart failure patients after discharge.
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Colville GA. Mental Health Provision in PICU: An Analysis of Referrals to an Embedded Psychologist Over 20 Years at a Single Center. Pediatr Crit Care Med 2023; 24:e592-e601. [PMID: 37638788 DOI: 10.1097/pcc.0000000000003341] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/29/2023]
Abstract
OBJECTIVES The main aim of this study was to illustrate the type of mental health provision possible on PICU by describing the nature of referrals of child patients and their parents to an embedded psychologist over a 20-year period, adding to the literature on intervention and service development. DESIGN Retrospective evaluation of anonymized departmental database. SETTING Twelve-bed PICU at a teaching hospital in a major urban center. PATIENTS Five hundred forty-five consecutive referrals for support for parent and/or child by PICU staff between 1998 and 2017. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Referrals increased from seven of 288 (2.4%) in 1998 to 85 of 643 (13.2%) in 2017. The majority were for parent support initially (456/545, 84%). Mean ( sd ) number of contacts was 4.5 (10.2), range 1 to 143, and mode was 1. Patient gender and age typical of the total PICU population, but referrals were more common where children had an oncology or trauma diagnosis ( p < 0.001). Comparisons with other inpatient referrals at the same hospital revealed a higher proportion of requests were made for parent support on PICU (456/545 [84%] vs 789/1,997 [40%]; p < 0.001) and that nurses were more likely to initiate referrals on PICU than on the other wards (437/543 [80%] vs 1,190/1,993 [60%]; p < 0.001). In other respects, the two groups were similar in terms of number of sessions, waiting times, and attendance rates. CONCLUSIONS Growing appreciation of the psychological impact of a child's admission to PICU has been associated with increasing referral to an embedded psychologist over a 20-year period, at this center. Clinical and service implications are outlined in the context of the latest research on the mitigation of post-intensive care syndrome in this population.
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Affiliation(s)
- Gillian A Colville
- Paediatric Psychology Service, St George's University Hospitals NHS Foundation Trust, London, United Kingdom
- New affiliation for Dr. Colville: Population Health Research Institute, St George's, University of London, London, United Kingdom
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Pryce P, Gangopadhyay M, Edwards JD. Parental Adverse Childhood Experiences and Post-PICU Stress in Children and Parents. Pediatr Crit Care Med 2023; 24:1022-1032. [PMID: 37615404 DOI: 10.1097/pcc.0000000000003339] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/25/2023]
Abstract
OBJECTIVES Hospitalization in a PICU is a stressful experience for children and their parents, with many experiencing posttraumatic stress disorder (PTSD) after discharge. Risk factors may include preillness traumatic events, such as adverse childhood experiences (ACEs). We sought to assess the feasibility of screening ACEs in parents of children admitted to a PICU, their prevalence, and their association with post-PICU PTSD symptoms in them and their children. DESIGN Single-center prospective observational study. SETTING Urban academic children's hospital from January to December 2021. PATIENTS One hundred forty-five children (2-18 yr old, admitted ≥ 2 d) and their parents. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Data on parental demographics, ACEs, coping skills, and PICU environmental stressors, as well as patient clinical data, were collected. One month after PICU discharge, parents completed inventories assessing PTSD symptoms in them and their children. Bivariate and logistic regression analyses were used to explore associations of ACEs with post-PICU PTSD. Of 145 enrolled parents, 95% completed the ACE questionnaire, 58% of whom reported greater than or equal to 1 ACE, and 14% had substantial (≥ 4) ACEs. Parent and patient follow-up was 79% and 70%, respectively. Sixteen percent of parents had provisional PTSD. Regression analysis showed parents with greater than or equal to 4 ACEs had 10 times greater odds of parental PTSD, compared to parents with less than 4 ACEs, (adjusted odds ratio [aOR] = 10.2; 95% CI, 1.03-100.9; p = 0.047). Fifty-six percent of patients screened at risk for PTSD. There was no association between substantial parental ACEs and patients' risk for PTSD (aOR = 3.5 [95% CI, 0.56-21.31]; p = 0.18). CONCLUSIONS ACEs were common among parents of critically ill children. Having substantial parental ACEs was associated with provisional parental PTSD after their child's PICU admission, but not with PTSD in the children. Family-centered care that seeks to mitigate post-PICU stress should be mindful of the potential relevance of parental ACEs.
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Affiliation(s)
- Patrice Pryce
- Section of Critical Care, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, New York, NY
| | - Maalobeeka Gangopadhyay
- Division of Child and Adolescent Psychiatry, Department of Psychiatry, Columbia University Vagelos College of Physicians and Surgeons, New York, NY
| | - Jeffrey D Edwards
- Section of Critical Care, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, New York, NY
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Vlug LE, Legerstee JS, Tabbers MM, Demirok A, Verloop MW, Bosman L, Rings EH, Wijnen RM, Spoel M, de Koning BA. Children with Intestinal Failure are at Risk for Psychopathology and Trauma. J Pediatr Gastroenterol Nutr 2023; 77:e104-e113. [PMID: 37679874 PMCID: PMC10642705 DOI: 10.1097/mpg.0000000000003939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 08/30/2023] [Indexed: 09/09/2023]
Abstract
OBJECTIVES The objective of this study is to assess the psychopathology and medical traumatic stress in children with intestinal failure (IF) and identify associated risk factors. METHODS Two-center study, performed from September 2019 until April 2022 (partly during COVID-19 pandemic), including children (1.5-17 years) with IF, dependent on parenteral nutrition (PN) or weaned off PN, treated by a multidisciplinary IF-team. Psychopathology in children was evaluated with a semi-structured interview assessing psychiatric classifications and validated questionnaires assessing emotional (internalizing) and behavioral (externalizing) problems. Medical traumatic stress was assessed with a validated questionnaire. Problem scores were compared with normative data. Associations between clinical characteristics and outcomes were analyzed with linear regression analyses. RESULTS Forty-one (of 111 eligible) children were included [median age 8.9 years (interquartile range, IQR 5.5-11.8), 54% female, 73% born preterm]. Median PN-duration was 17.3 months (IQR 6.9-54.0); 17 children (41%) were still PN-dependent. One third of the children met criteria for at least 1 psychiatric classification (compared with 14% in age-matched general population). Anxiety disorders and attention deficit hyperactivity disorder were most common. In school-aged children (n = 29, 6-17 years), significantly increased emotional problems were consistently reported by children ( P = 0.011), parents ( P < 0.001), and teachers ( P = 0.004). In preschool children (n = 12, 1.5-5 years), no significant differences with normative data were found. Subclinical or clinical emotional problems were reported in 19 children (46%). Medical traumatic stress was present in 14%, and 22% of children had received psychological help for trauma before. Lower gastrointestinal related quality of life was associated with more emotional problems, but not PN-duration. CONCLUSIONS Children with IF, particularly school-aged children, are at risk for psychological problems which is reflected by the high rate of received psychotherapy and the high rate of emotional problems and psychiatric classifications.
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Affiliation(s)
- Lotte E. Vlug
- From the Department of Pediatrics, Division of Gastroenterology, Erasmus MC Sophia Children’s Hospital, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Jeroen S. Legerstee
- the Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC Sophia Children’s Hospital, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Merit M. Tabbers
- the Department of Pediatrics, Division of Gastroenterology, AMC Emma Children’s Hospital, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Aysenur Demirok
- the Department of Pediatrics, Division of Gastroenterology, AMC Emma Children’s Hospital, Amsterdam University Medical Center, Amsterdam, The Netherlands
| | - Merel W. Verloop
- the Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC Sophia Children’s Hospital, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Lotte Bosman
- the Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC Sophia Children’s Hospital, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Edmond H.H.M. Rings
- From the Department of Pediatrics, Division of Gastroenterology, Erasmus MC Sophia Children’s Hospital, University Medical Center Rotterdam, Rotterdam, The Netherlands
- the Department of Pediatrics, Division of Gastroenterology, Willem Alexander Children’s Hospital, Leiden University Medical Center, Leiden, The Netherlands
| | - René M.H. Wijnen
- the Department of Pediatric Surgery, Erasmus MC Sophia Children’s Hospital, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Marjolein Spoel
- the Department of Pediatric Surgery, Erasmus MC Sophia Children’s Hospital, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Barbara A.E. de Koning
- From the Department of Pediatrics, Division of Gastroenterology, Erasmus MC Sophia Children’s Hospital, University Medical Center Rotterdam, Rotterdam, The Netherlands
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Laures E, Williams J, McCarthy AM. Pain assessment & management decision-making in pediatric critical care. J Pediatr Nurs 2023; 73:e494-e502. [PMID: 37884405 DOI: 10.1016/j.pedn.2023.10.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 10/17/2023] [Accepted: 10/17/2023] [Indexed: 10/28/2023]
Abstract
PURPOSE The aim of this study was to explore how nurses in the Pediatric Intensive Care Unit (PICU) reach their pain management decisions in children who are mechanically ventilated and chemically paralyzed. DESIGN AND METHODS A qualitative descriptive design was used following a quantitative phase of a multi-method study. Eighteen PICU nurses participated in semi-structured interviews aiming at understanding how they assess pain and make management decisions. Content analysis was used to guide coding and generate themes. RESULTS Three major themes were identified: 1) Assessment or cues that nurses use to trigger a pain assessment; 2) Mental models or patterns that nurses create to interpret cues to guide decision-making; 3) External factors that inhibit or facilitate decision-making. Overall, nurses rely on physiological cues to assess pain. From there, a large amount of variation exists on how nurses interpret those cues to make their pain management decision. External factors such as unit culture, perceived barriers and facilitators, and the nurse's experiences impacted how decisions are made. CONCLUSIONS Variation exists in the mental models' nurses create to make their pain management decision in this population. Nurses reported confusion on pain and sedation scale selection and various documentation practices for pain assessment. "Assume pain present" was identified as a concept and documentation practice that may guide decisions; further research is needed. PRACTICE IMPLICATIONS Development of clinician decision support tools that not only aid their understanding of reliable pain cues but also help create clear documentation practices may help nurses make pain management decisions.
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Affiliation(s)
- Elyse Laures
- University of Iowa College of Nursing, 50 Newton Drive, Iowa City, IA 52242, United States of America; University of Iowa Hospitals & Clinics, 200 Hawkins Drive, Iowa City, IA 52242, United States of America.
| | - Janet Williams
- University of Iowa College of Nursing, 50 Newton Drive, Iowa City, IA 52242, United States of America
| | - Ann Marie McCarthy
- University of Iowa College of Nursing, 50 Newton Drive, Iowa City, IA 52242, United States of America
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Abstract
Children who survive the pediatric intensive care unit (PICU) are at risk of developing post-intensive care syndrome in pediatrics (PICS-p). PICS-p, defined as new physical, cognitive, emotional, and/or social health dysfunction following critical illness, can affect the child and family. Historically, synthesizing PICU outcomes research has been challenging due to inconsistency in study design and in outcomes measurement. PICS-p risk may be mitigated by implementing intensive care unit best practices that limit iatrogenic injury and by supporting the resiliency of critically ill children and their families.
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Olszewski AE, Dervan LA, Smith MB, Asaro LA, Wypij D, Curley MAQ, Watson RS. Risk Factors for Positive Post-Traumatic Stress Disorder Screening and Associated Outcomes in Children Surviving Acute Respiratory Failure: A Secondary Analysis of the Randomized Evaluation of Sedation Titration for Respiratory Failure Clinical Trial. Pediatr Crit Care Med 2023; 24:222-232. [PMID: 36728954 PMCID: PMC9992163 DOI: 10.1097/pcc.0000000000003150] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVES To identify risk factors and outcomes associated with a positive post-traumatic stress disorder (PTSD) screen following pediatric acute respiratory failure treated with invasive mechanical ventilation. DESIGN Nonprespecified secondary analysis of a randomized clinical trial. SETTING Thirty-one U.S. PICUs. PATIENTS Children in the Randomized Evaluation of Sedation Titration for Respiratory Failure (RESTORE) trial (NCT00814099, ClinicalTrials.gov ) over 8 years old who completed PTSD screening 6 months after discharge. INTERVENTIONS RESTORE sites were randomized to a targeted, nurse-directed sedation strategy versus usual care. MEASUREMENTS AND MAIN RESULTS PTSD screening was completed by 102 subjects using the Child Post-Traumatic Stress Disorder Symptom Scale; a score of greater than or equal to 11 was considered screening positive for PTSD. Cognitive status was categorized using Pediatric Cerebral Performance Category; health-related quality of life (HRQL) was evaluated using child-reported Pediatric Quality of Life Inventory, Version 4.0. Thirty-one children (30%) screened positive for PTSD. Children with a positive screen endorsed symptoms in all categories: reexperiencing, avoidance, and hyperarousal. Most endorsed that symptoms interfered with schoolwork ( n = 18, 58%) and happiness ( n = 17, 55%). Screening positive was not associated with RESTORE treatment group. In a multivariable logistic model adjusting for age, sex, and treatment group, screening positive was independently associated with lower median income in the family's residential zip code (compared with income ≥ $80,000; income < $40,000 odds ratio [OR], 32.8; 95% CI, 2.3-458.1 and $40,000-$79,999 OR, 15.6; 95% CI, 1.3-182.8), renal dysfunction (OR 5.3, 95% CI 1.7-16.7), and clinically significant pain in the PICU (OR, 8.3; 95% CI, 1.9-35.7). Children with a positive screen experienced decline in cognitive function and impaired HRQL more frequently than children with a negative screen. CONCLUSIONS Screening positive for PTSD is common among children following acute respiratory failure and is associated with lower HRQL and decline in cognitive function. Routine PTSD screening may be warranted to optimize recovery.
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Affiliation(s)
- Aleksandra E Olszewski
- Division of Bioethics and Palliative Care, Department of Pediatrics, University of Washington, Seattle, WA
| | - Leslie A Dervan
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Washington, Seattle, WA
- Center for Clinical & Translational Research, Seattle Children's Research Institute, Seattle, WA
| | - Mallory B Smith
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Washington, Seattle, WA
- Harborview Injury Prevention & Research Center, University of Washington, Seattle, WA
| | - Lisa A Asaro
- Department of Cardiology, Boston Children's Hospital, Boston, MA
| | - David Wypij
- Division of Bioethics and Palliative Care, Department of Pediatrics, University of Washington, Seattle, WA
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Washington, Seattle, WA
- Center for Clinical & Translational Research, Seattle Children's Research Institute, Seattle, WA
- Harborview Injury Prevention & Research Center, University of Washington, Seattle, WA
- Department of Cardiology, Boston Children's Hospital, Boston, MA
- Department of Biostatistics, Harvard T. H. Chan School of Public Health, Boston, MA
- Department of Pediatrics, Harvard Medical School, Boston, MA
- Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia, PA
- Research Institute, Children's Hospital of Philadelphia, Philadelphia, PA
- Center for Child Health, Behavior, & Development, Seattle Children's Research Institute, Seattle, WA
| | - Martha A Q Curley
- Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia, PA
- Research Institute, Children's Hospital of Philadelphia, Philadelphia, PA
| | - R Scott Watson
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Washington, Seattle, WA
- Center for Child Health, Behavior, & Development, Seattle Children's Research Institute, Seattle, WA
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Long DA, Waak M, Doherty NN, Dow BL. Brain-Directed Care: Why Neuroscience Principles Direct PICU Management beyond the ABCs. CHILDREN (BASEL, SWITZERLAND) 2022; 9:children9121938. [PMID: 36553381 PMCID: PMC9776953 DOI: 10.3390/children9121938] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 12/02/2022] [Accepted: 12/06/2022] [Indexed: 12/14/2022]
Abstract
Major advances in pediatric intensive care (PICU) have led to increased child survival. However, the long-term outcomes among these children following PICU discharge are a concern. Most children admitted to PICU are under five years of age, and the stressors of critical illness and necessary interventions can affect their ability to meet crucial developmental milestones. Understanding the neuroscience of brain development and vulnerability can inform PICU clinicians of new ways to enhance and support the care of these most vulnerable children and families. This review paper first explores the evidence-based neuroscience principles of brain development and vulnerability and the impact of illness and care on children's brains and ultimately wellbeing. Implications for clinical practice and training are further discussed to help optimize brain health in children who are experiencing and surviving a critical illness or injury.
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Affiliation(s)
- Debbie A. Long
- School of Nursing, Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, QLD 4059, Australia
- Paediatric Intensive Care Unit, Queensland Children’s Hospital, Brisbane, QLD 4101, Australia
- Centre for Children’s Health Research, The University of Queensland, Brisbane, QLD 4101, Australia
- Correspondence: ; Tel.: +61-7-3138-3834
| | - Michaela Waak
- Paediatric Intensive Care Unit, Queensland Children’s Hospital, Brisbane, QLD 4101, Australia
- Centre for Children’s Health Research, The University of Queensland, Brisbane, QLD 4101, Australia
| | - Nicola N. Doherty
- Regional Trauma Network, SPPG, DOH, Belfast BT2 8BS, Northern Ireland, UK
- School of Psychology, Faculty of Life and Health Sciences, Coleraine Campus, Ulster University, Coleraine BT52 1SA, Northern Ireland, UK
| | - Belinda L. Dow
- School of Nursing, Centre for Healthcare Transformation, Queensland University of Technology, Brisbane, QLD 4059, Australia
- Centre for Children’s Health Research, The University of Queensland, Brisbane, QLD 4101, Australia
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Leoz Gordillo I, García Remiro J, Barbero Peco C, Alonso Pérez A, García Salido A, González Brabin A, Cabrero Hernández M, Nieto Moro M. Sequelae in children with severe SARS-CoV-2-related disease requiring Intensive Care: Description and comparison with other reasons for admission. MEDICINA INTENSIVA (ENGLISH EDITION) 2022; 46:585-587. [PMID: 35879184 PMCID: PMC9250885 DOI: 10.1016/j.medine.2022.06.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Revised: 12/10/2021] [Accepted: 12/18/2021] [Indexed: 10/29/2022]
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O'Toole S, Suarez C, Adair P, McAleese A, Willis S, McCormack D. A Systematic Review of the Factors Associated with Post-Traumatic Growth in Parents Following Admission of Their Child to the Intensive Care Unit. J Clin Psychol Med Settings 2022; 29:509-537. [PMID: 35526209 PMCID: PMC9399044 DOI: 10.1007/s10880-022-09880-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/13/2022] [Indexed: 12/01/2022]
Abstract
This systematic review aims to identify the demographic, clinical and psychological factors associated with post-traumatic growth (PTG) in parents following their child's admission to the intensive care unit (ICU). Papers published up to September 2021 were identified following a search of electronic databases (PubMed, Medline, Web of Science, PsycINFO, CINAHL, PTSDpubs and EMBASE). Studies were included if they involved a sample of parents whose children were previously admitted to ICU and reported correlational data. 1777 papers were reviewed. Fourteen studies were eligible for inclusion; four were deemed to be of good methodological quality, two were poor, and the remaining eight studies were fair. Factors associated with PTG were identified. Mothers, and parents of older children, experienced greater PTG. Parents who perceived their child's illness as more severe had greater PTG. Strong associations were uncovered between PTG and post-traumatic stress, psychological well-being and coping. PTG is commonly experienced by this population. Psychological factors are more commonly associated with PTG in comparison with demographic and clinical factors, suggesting that parents' subjective ICU experience may be greater associated with PTG than the objective reality.
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Affiliation(s)
- S O'Toole
- School of Psychology, Queen's University Belfast, David Keir Building, 18-30 Malone Road, Belfast, BT9 5BN, UK.
| | - C Suarez
- School of Psychology, Queen's University Belfast, David Keir Building, 18-30 Malone Road, Belfast, BT9 5BN, UK
| | - P Adair
- School of Psychology, Queen's University Belfast, David Keir Building, 18-30 Malone Road, Belfast, BT9 5BN, UK
| | - A McAleese
- Clinical Psychology Department, Royal Belfast Hospital for Sick Children, Belfast, UK
| | - S Willis
- Clinical Psychology Department, Royal Belfast Hospital for Sick Children, Belfast, UK
| | - D McCormack
- School of Psychology, Queen's University Belfast, David Keir Building, 18-30 Malone Road, Belfast, BT9 5BN, UK
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Stanzel A, Sierau S. Pediatric Medical Traumatic Stress (PMTS) following Surgery in Childhood and Adolescence: a Systematic Review. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2022; 15:795-809. [PMID: 35958723 PMCID: PMC9360277 DOI: 10.1007/s40653-021-00391-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/22/2021] [Indexed: 05/22/2023]
Abstract
UNLABELLED The purpose of the present review was to systematically review, synthesize and quantify prevalence rates of subclinical and clinical psychological symptoms in children and adolescents who have undergone surgery. Systematic literature searches were conducted twofold in April 8, 2020 and March 7, 2021 in PsycInfo and PubMed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Manuscripts were screened against eligibility criteria and were included if they investigated psychological symptoms in children or adolescents (age between 1 to 21 years at the time of study) who were hospitalized for pediatric surgery. Means and standard deviations weighted by sample size were calculated. Eleven articles met inclusion criteria. The review revealed that a small but substantial number of children and adolescents are at an elevated risk for postoperative psychological symptoms and disorders. Up to 13% had symptoms consistent with a diagnosis of a posttraumatic stress disorder, 6% to 8% exhibited elevated symptoms of depression or anxiety, and about 25% showed internalizing and externalizing symptoms. This review provides preliminary evidence that children and adolescents experience significant psychological distress and posttraumatic stress symptoms after pediatric surgery. Apart from better training of clinicians, prevention, early psychological screening and psychosocial care in surgical wards of hospitals are recommended. Well-designed studies of high methodological quality are necessary to replicate existing findings and provide a broader base of evidence. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1007/s40653-021-00391-9.
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Affiliation(s)
- Anna Stanzel
- Department of Clinical Child and Adolescent Psychology, Institute of Psychology, Leipzig University, Leipzig, Germany
| | - Susan Sierau
- Department of Clinical Child and Adolescent Psychology, Institute of Psychology, Leipzig University, Leipzig, Germany
- Department of Medical Psychology and Medical Sociology, Leipzig University, Leipzig, Germany
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Back to School: Academic Functioning and Educational Needs among Youth with Acquired Brain Injury. CHILDREN 2022; 9:children9091321. [PMID: 36138630 PMCID: PMC9497748 DOI: 10.3390/children9091321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 08/19/2022] [Accepted: 08/24/2022] [Indexed: 11/17/2022]
Abstract
Youth with a history of traumatic or non-traumatic acquired brain injury are at increased risk for long-lasting cognitive, emotional, behavioral, social, and physical sequelae post-injury. Such sequelae have great potential to negatively impact this population’s academic functioning. Consistently, poorer academic achievement and elevated need for educational supports have been well-documented among youth with a history of acquired brain injury. The current paper reviews the literature on neuropsychological, psychiatric, and academic outcomes of pediatric acquired brain injury. A discussion of special education law as it applies to this patient population, ongoing limitations within the field, and a proposal of solutions are also included.
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14
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Sobotka SA, Lynch EJ, Dholakia AV, Mayampurath A, Pinto NP. PICU Survivorship: Factors Affecting Feasibility and Cohort Retention in a Long-Term Outcomes Study. CHILDREN (BASEL, SWITZERLAND) 2022; 9:1041. [PMID: 35884025 PMCID: PMC9317147 DOI: 10.3390/children9071041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Revised: 07/08/2022] [Accepted: 07/11/2022] [Indexed: 06/15/2023]
Abstract
Our understanding of longitudinal outcomes of Pediatric Intensive Care Unit (PICU) survivors is limited by the heterogeneity of follow-up intervals, populations, and outcomes assessed. We sought to demonstrate (1) the feasibility of longitudinal multidimensional outcome assessment and (2) methods to promote cohort retention. The objective of this presented study was to provide details of follow-up methodology in a PICU survivor cohort and not to present the outcomes at long-term follow-up for this cohort. We enrolled 152 children aged 0 to 17 years admitted to the PICU in a prospective longitudinal cohort study. We examined resource utilization, family impact of critical illness, and neurodevelopment using the PICU Outcomes Portfolio (POP) Survey which included a study-specific survey and validated tools: 1. Functional Status Scale, 2. Pediatric Evaluation of Disability Inventory Computer Adaptive Test, 3. Pediatric Quality of Life Inventory, 4. Strengths and Difficulties Questionnaire, and 5. Vanderbilt Assessment Scales for Attention Deficit-Hyperactivity Disorder. POP Survey completion rates were 89%, 78%, and 84% at 1, 3, and 6 months. Follow-up rates at 1, 2, and 3 years were 80%, 55%, and 43%. Implementing a longitudinal multidimensional outcome portfolio for PICU survivors is feasible within an urban, tertiary-care, academic hospital. Our attrition after one year demonstrates the long-term follow-up challenges in this population. Our findings inform ongoing efforts to implement core outcome sets after pediatric critical illness.
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Affiliation(s)
- Sarah A. Sobotka
- Section of Developmental and Behavioral Pediatrics, Department of Pediatrics, The University of Chicago, 950 East 61st Street, Suite 207, Chicago, IL 60637, USA;
| | - Emma J. Lynch
- Section of Developmental and Behavioral Pediatrics, Department of Pediatrics, The University of Chicago, 950 East 61st Street, Suite 207, Chicago, IL 60637, USA;
| | - Ayesha V. Dholakia
- Department of Pediatrics, Boston Children’s Hospital, Boston, MA 02115, USA;
| | - Anoop Mayampurath
- Department of Biostatistics & Medical Informatics, The University of Wisconsin-Madison, Madison, WI 53705, USA;
| | - Neethi P. Pinto
- Division of Critical Care Medicine, Department of Anesthesiology and Critical Medicine, Children’s Hospital of Philadelphia, Philadelphia, PA 19104, USA;
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Hall TA, Greene RK, Lee JB, Leonard S, Bradbury KR, Drury K, Recht G, Randall J, Norr ME, Williams CN. Post-Intensive Care Syndrome in a Cohort of School-Aged Children and Adolescent ICU Survivors: The Importance of Follow-up in the Acute Recovery Phase. J Pediatr Intensive Care 2022. [DOI: 10.1055/s-0042-1747935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
AbstractPediatric intensive care unit (PICU) survivors experience a collection of physical, cognitive, emotional, and social symptoms named post-intensive care syndrome (PICS). We aimed to quantify PICS morbidities from multiple stakeholder perspectives across domains. Using physician, neuropsychologist, and parent/caregiver-completed outcome measures across domains in a cross-sectional analysis of 186 children between the ages of 8 and 19 years with data from a PICU follow-up clinic 1 to 3 months after PICU discharge, we quantified PICS morbidities and used Spearman correlation to evaluate interdependence of PICS domains. Compared with pre-hospitalization functioning, new PICS-related morbidities were observed and significant correlations were identified between the PICS domains. Results highlight the need to identify and support patients and families for multiple morbidities simultaneously across all relevant PICS domains; moreover, an important divergence between caregiver report, physician, and neuropsychologist assessment was also found, showcasing the importance of multiple assessments and perspectives. New PICS morbidities across domains are common after discharge from the PICU, and timely follow-up care is needed that involves collaboration/integration of physicians, neuropsychologists, youth, and families to effectively identify and treat PICS-related issues.
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Affiliation(s)
- Trevor A. Hall
- Division of Pediatric Psychology, Department of Pediatrics, Oregon Health & Science University, Portland, Oregon, United States
- Pediatric Critical Care and Neurotrauma Recovery Program, Oregon Health & Science University, Portland, Oregon, United States
| | - Rachel K. Greene
- Division of Pediatric Psychology, Department of Pediatrics, Oregon Health & Science University, Portland, Oregon, United States
| | - Justin B. Lee
- Division of Pediatric Psychology, Department of Pediatrics, Oregon Health & Science University, Portland, Oregon, United States
| | - Skyler Leonard
- Division of Pediatric Psychology, Department of Pediatrics, Oregon Health & Science University, Portland, Oregon, United States
| | - Kathryn R. Bradbury
- Children's Neuropsychological Services, Andover, Massachusetts, United States
| | - Kurt Drury
- Pediatric Critical Care and Neurotrauma Recovery Program, Oregon Health & Science University, Portland, Oregon, United States
- Division of Critical Care, Department of Pediatrics, Oregon Health & Science University, Portland, Oregon, United States
| | - Grace Recht
- Pediatric Critical Care and Neurotrauma Recovery Program, Oregon Health & Science University, Portland, Oregon, United States
| | - Julie Randall
- Pediatric Critical Care and Neurotrauma Recovery Program, Oregon Health & Science University, Portland, Oregon, United States
| | - Megan E. Norr
- Division of Pediatric Psychology, Department of Pediatrics, Oregon Health & Science University, Portland, Oregon, United States
| | - Cydni N. Williams
- Pediatric Critical Care and Neurotrauma Recovery Program, Oregon Health & Science University, Portland, Oregon, United States
- Division of Critical Care, Department of Pediatrics, Oregon Health & Science University, Portland, Oregon, United States
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16
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Kerbage H, Bazzi O, El Hage W, Corruble E, Purper-Ouakil D. Early Interventions to Prevent Post-Traumatic Stress Disorder in Youth after Exposure to a Potentially Traumatic Event: A Scoping Review. Healthcare (Basel) 2022; 10:healthcare10050818. [PMID: 35627955 PMCID: PMC9141228 DOI: 10.3390/healthcare10050818] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 04/19/2022] [Accepted: 04/25/2022] [Indexed: 12/04/2022] Open
Abstract
The worldwide occurrence of potentially traumatic events (PTEs) in the life of children is highly frequent. We aimed to identify studies on early mental health interventions implemented within three months of the child/adolescent’s exposure to a PTE, with the aim of reducing acute post-traumatic symptoms, decreasing long term PTSD, and improving the child’s adjustment after a PTE exposure. The search was performed in PubMed and EMBASE databases resulting in twenty-seven articles meeting our inclusion criteria. Most non-pharmacological interventions evaluated had in common two complementary components: psychoeducation content for both children and parents normalizing early post-traumatic responses while identifying post-traumatic symptoms; and coping strategies to deal with post-traumatic symptoms. Most of these interventions studied yielded positive results on outcomes with a decrease in post-traumatic, anxiety, and depressive symptoms. However, negative results were noted when traumatic events were still ongoing (war, political violence) as well as when there was no or little parental involvement. This study informs areas for future PTSD prevention research and raises awareness of the importance of psychoeducation and coping skills building in both youth and their parents in the aftermath of a traumatic event, to strengthen family support and prevent the occurrence of enduring post-traumatic symptoms.
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Affiliation(s)
- Hala Kerbage
- Department of Child and Adolescent Psychiatry, Saint Eloi University Hospital, 34090 Montpellier, France
- Center for Epidemiology and Population Health (CESP), INSERM U1018, Developmental Psychiatry Team, Paris-Saclay University, Villejuif CEDEX, 94807 Paris, France
- Correspondence: ; Tel.: +33601819449
| | - Ola Bazzi
- Faculty of Health Sciences, American University of Beirut, Beirut 1107 2020, Lebanon;
| | - Wissam El Hage
- Center of Clinical Investigation iBrain 1253, University of Tours, 37032 Tours, France;
| | - Emmanuelle Corruble
- CESP, MOODS Team, INSERM U1018, School of Medicine, Paris-Saclay University, Kremlin Bicetre, 94275 Paris, France;
- Department of Psychiatry, Paris-Saclay University Hospital, Kremlin Bicetre, 94275 Paris, France;
| | - Diane Purper-Ouakil
- Department of Psychiatry, Paris-Saclay University Hospital, Kremlin Bicetre, 94275 Paris, France;
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17
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Ko MSM, Poh PF, Heng KYC, Sultana R, Murphy B, Ng RWL, Lee JH. Assessment of Long-term Psychological Outcomes After Pediatric Intensive Care Unit Admission: A Systematic Review and Meta-analysis. JAMA Pediatr 2022; 176:e215767. [PMID: 35040918 PMCID: PMC8767488 DOI: 10.1001/jamapediatrics.2021.5767] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
IMPORTANCE 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. RESULTS Of 9193 records identified, 31 independent studies (5 randomized clinical trials and 26 observational studies) involving 7786 children (mean age, 7.3 years [95% CI, 6.2-8.4 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 follow-up (mean, 89.40 points [95% CI, 88.33-90.47 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, 45.20-48.13 points]; P < .001). CONCLUSIONS AND RELEVANCE This systematic review and meta-analysis found a high burden of psychological sequelae among children previously admitted to the PICU, suggesting that risk stratification and early interventions are needed for high-risk groups.
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Affiliation(s)
| | - Pei-Fen Poh
- Children’s Intensive Care Unit, KK Women’s and Children’s Hospital, Singapore
| | | | - Rehena Sultana
- Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore
| | - Beverly Murphy
- Medical Center Library and Archives, Duke University, Durham, North Carolina
| | - Regina Wan Leng Ng
- Children’s Intensive Care Unit, KK Women’s and Children’s Hospital, Singapore
| | - Jan Hau Lee
- MD Programme, Duke-NUS Medical School, Singapore,Children’s Intensive Care Unit, KK Women’s and Children’s Hospital, Singapore
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18
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Gordillo IL, Remiro JG, Peco CB, Pérez AA, Salido AG, Brabin AG, Hernández MC, Moro MN. [Sequelae in children with severe SARS-CoV-2-related disease requiring Intensive Care: description and comparison with other reasons for admission.]. Med Intensiva 2022; 46:585-587. [PMID: 35017769 PMCID: PMC8739030 DOI: 10.1016/j.medin.2021.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Inés Leoz Gordillo
- Médico del Servicio de Cuidados Intensivos pediátricos. Hospital Infantil Universitario Niño Jesús, Madrid, España
| | - Jessica García Remiro
- Enfermera del Servicio de Cuidados Intensivos pediátricos. Hospital Infantil Universitario Niño Jesús, Madrid, España
| | - Consuelo Barbero Peco
- Enfermera del Servicio de Cuidados Intensivos pediátricos. Hospital Infantil Universitario Niño Jesús, Madrid, España
| | | | - Alberto García Salido
- Médico del Servicio de Cuidados Intensivos pediátricos. Hospital Infantil Universitario Niño Jesús, Madrid, España
| | - Anthony González Brabin
- Médico del Servicio de Cuidados Intensivos pediátricos. Hospital Infantil Universitario Niño Jesús, Madrid, España
| | - Marta Cabrero Hernández
- Médico del Servicio de Cuidados Intensivos pediátricos. Hospital Infantil Universitario Niño Jesús, Madrid, España
| | - Montserrat Nieto Moro
- Médico del Servicio de Cuidados Intensivos pediátricos. Hospital Infantil Universitario Niño Jesús, Madrid, España
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19
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Ravikumar N, Sankar J, Das RR. Functional Outcomes in Survivors of Pediatric Sepsis: A Scoping Review and Discussion of Implications for Low- and Middle-Income Countries. Front Pediatr 2022; 10:762179. [PMID: 35345613 PMCID: PMC8957211 DOI: 10.3389/fped.2022.762179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Accepted: 01/11/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Pediatric sepsis is an important cause of mortality and morbidity in low- and middle-income countries (LMIC), where there is a huge burden of infectious diseases. Despite shortage of resources, adapting protocol-based care has reduced sepsis-related deaths but survivors of pediatric sepsis are at risk of poor functional outcomes. OBJECTIVES To perform a scoping review of the literature on functional outcomes of pediatric sepsis survivors after discharge from the intensive care unit (ICU) and discuss the implications for patients in LMICs. The outcomes include prevalence of survival with reduced functional outcomes or quality of life (QoL) and changes over time during follow-up or recovery, and these outcomes were compared with other groups of children. METHODS We searched major medical electronic databases for relevant literature from January 2005 until November 2021, including Medline (via PubMed), Embase, CINAHL, and Google Scholar databases. We included observational studies and follow-up data from clinical trials involving children/adolescents (≤18 years) who were admitted to pediatric intensive care unit (PICU) and got discharged finally. Major focus was on survivors of sepsis in LMIC. We followed PRISMA guidelines for scoping reviews (PRISM-ScR). RESULTS We included eight papers reporting data of functional outcomes in 2,915 children (males = 53%, and comorbidity present in 56.6%). All included studies were either a prospective or retrospective cohort study. Studies were classified as Level II evidence. Disabilities affecting physical, cognitive, psychological, and social function were reported in children following discharge. Overall disability reported ranged between 23 and 50% at hospital discharge or 28 days. Residual disability was reported at 1, 3, 6, and 12 months of follow-up with an overall improving trend. Failure to recover from a baseline HRQL on follow-up was seen in one-third of survivors. Organ dysfunction scores such as pSOFA, PeLOD, vasoactive inotrope score, neurological events, immunocompromised status, need for CPR, and ECMO were associated with poor functional outcome. CONCLUSIONS The research on functional outcomes in pediatric sepsis survivors is scarce in LMIC. Measuring baseline and follow-up functional status, low-cost interventions to improve management of sepsis, and multidisciplinary teams to identify and treat disabilities may improve functional outcomes.
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Affiliation(s)
- Namita Ravikumar
- Division of Pediatric Pulmonology and Critical Care, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Jhuma Sankar
- Division of Pediatric Pulmonology and Critical Care, Department of Pediatrics, All India Institute of Medical Sciences, New Delhi, India
| | - Rashmi Ranjan Das
- Department of Pediatrics, All India Institute of Medical Sciences, Bhubaneswar, India
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20
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Geneslaw AS, Lu Y, Miles CH, Hua M, Cappell J, Smerling AJ, Olfson M, Edwards JD, Ing C. Long-Term Increases in Mental Disorder Diagnoses After Invasive Mechanical Ventilation for Severe Childhood Respiratory Disease: A Propensity Matched Observational Cohort Study. Pediatr Crit Care Med 2021; 22:1013-1025. [PMID: 34261946 PMCID: PMC10193693 DOI: 10.1097/pcc.0000000000002790] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To evaluate neurodevelopmental and mental disorders after PICU hospitalization in children requiring invasive mechanical ventilation for severe respiratory illness. DESIGN Retrospective longitudinal observational cohort. SETTING Texas Medicaid Analytic eXtract data from 1999 to 2012. PATIENTS Texas Medicaid-enrolled children greater than or equal to 28 days old to less than 18 years old hospitalized for a primary respiratory illness, without major chronic conditions predictive of abnormal neurodevelopment. INTERVENTIONS We examined rates of International Classification of Diseases, 9th revision-coded mental disorder diagnoses and psychotropic medication use following discharge among children requiring invasive mechanical ventilation for severe respiratory illness, compared with general hospital patients propensity score matched on sociodemographic and clinical characteristics prior to admission. Children admitted to the PICU for respiratory illness not necessitating invasive mechanical ventilation were also compared with matched general hospital patients as a negative control exposure. MEASUREMENTS AND MAIN RESULTS Of 115,335 eligible children, 1,351 required invasive mechanical ventilation and were matched to 6,755 general hospital patients. Compared with general hospital patients, children requiring invasive mechanical ventilation had increased mental disorder diagnoses (hazard ratio, 1.43 [95% CI, 1.26-1.64]; p < 0.0001) and psychotropic medication use (hazard ratio, 1.67 [1.34-2.08]; p < 0.0001) following discharge. Seven-thousand seven-hundred eighty children admitted to the PICU without invasive mechanical ventilation were matched to 38,900 general hospital patients and had increased mental disorder diagnoses (hazard ratio, 1.08 [1.02-1.15]; p = 0.01) and psychotropic medication use (hazard ratio, 1.11 [1.00-1.22]; p = 0.049). CONCLUSIONS Children without major comorbidity requiring invasive mechanical ventilation for severe respiratory illness had a 43% higher incidence of subsequent mental disorder diagnoses and a 67% higher incidence of psychotropic medication use. Both increases were substantially higher than in PICU patients with respiratory illness not necessitating invasive mechanical ventilation. Invasive mechanical ventilation is a life-saving therapy, and its application is interwoven with underlying health, illness severity, and PICU management decisions. Further research is required to determine which factors related to invasive mechanical ventilation and severe respiratory illness are associated with abnormal neurodevelopment. Given the increased risk in these children, identification of strategies for prevention, neurodevelopmental surveillance, and intervention after discharge may be warranted.
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Affiliation(s)
- Andrew S Geneslaw
- Department of Pediatrics, Columbia University Irving Medical Center, New York, NY
| | - Yewei Lu
- Department of Anesthesiology, Columbia University Irving Medical Center, New York, NY
| | - Caleb H Miles
- Department of Biostatistics, Columbia University Mailman School of Public Health, New York, NY
| | - May Hua
- Departments of Anesthesiology and Epidemiology, Columbia University Irving Medical Center and Columbia University Mailman School of Public Health, New York, NY
| | - Joshua Cappell
- Department of Pediatrics, Columbia University Irving Medical Center, New York, NY
| | - Arthur J Smerling
- Department of Pediatrics, Columbia University Irving Medical Center, New York, NY
| | - Mark Olfson
- Departments of Psychiatry and Epidemiology, Columbia University Irving Medical Center and Columbia University Mailman School of Public Health, New York, NY
| | - Jeffrey D Edwards
- Department of Pediatrics, Columbia University Irving Medical Center, New York, NY
| | - Caleb Ing
- Departments of Anesthesia and Epidemiology, Columbia University Irving Medical Center and Columbia University Mailman School of Public Health, New York, NY
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21
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Post-Intensive Care Syndrome in Children: A Concept Analysis. J Pediatr Nurs 2021; 61:417-423. [PMID: 34687989 DOI: 10.1016/j.pedn.2021.10.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 09/29/2021] [Accepted: 10/11/2021] [Indexed: 11/21/2022]
Abstract
PROBLEM Post-intensive care syndrome in paediatrics (PICS-p) is a term used to describe newly acquired or worsened impairment in one or more aspects of a child's physical, psychological, cognitive, and social functioning after discharge from the paediatric intensive care unit (PICU). However, consensus, conceptual insights, and assessment guidance are lacking for this syndrome. Therefore, this analysis aimed to define the concept of PICS-p to help practitioners and researchers understand the syndrome in detail using the Walker and Avant approach. ELIGIBILITY CRITERIA We reviewed studies retrieved from several databases, namely PubMed, Google Scholar, Web of Science, Ovid, ScienceDirect, and the Springer database, using the following keywords: 'post-intensive care syndrome', 'PICU', 'children', 'PICS-p', and 'concept analysis'. Both quantitative and qualitative studies on PICS-p were included in the search. The articles were limited to those published up to November 21, 2020. SAMPLE Of the 762 publications selected, 24 publications met the inclusion criteria. RESULTS PICS-p is defined on the basis of the following aspects: (1) Physical dysfunction; (2) Cognitive dysfunction; (3) Psychological dysfunction; and (4) Social dysfunction. CONCLUSION With the increasing success rate of PICU treatment, reduced case fatality is no longer the only outcome of critical illness in children. The long-term outcomes in children discharged from hospitals have attracted attention from families, hospitals, and communities. IMPLICATIONS A clear definition of PICS-p will help medical staff understand PICS-p in detail and provide a theoretical basis for the diagnosis and treatment of this syndrome.
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22
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Lee LA, Moss SJ, Martin DA, Rosgen BK, Wollny K, Gilfoyle E, Fiest KM. Comfort-holding in critically ill children: a scoping review. Can J Anaesth 2021; 68:1695-1704. [PMID: 34405358 PMCID: PMC8370455 DOI: 10.1007/s12630-021-02090-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Revised: 06/15/2021] [Accepted: 06/17/2021] [Indexed: 11/07/2022] Open
Abstract
Purpose To understand and summarize the breadth of knowledge on comfort-holding in pediatric intensive care units (PICUs). Sources This scoping review was conducted using PRISMA methodology. A literature search was conducted in MEDLINE, EMBASE, PsycINFO, CINAHL, and the Cochrane CENTRAL Register of Controlled Trials. Search strategies were developed with a medical librarian and revised through a peer review of electronic search strategies. All databases were searched from inception to 14 April 2020. Only full-text articles available in English were included. All identified articles were reviewed independently and in duplicate using predetermined criteria. All study designs were eligible if they reported on comfort-holding in a PICU. Data were extracted independently and in duplicate. Principal findings Of 13,326 studies identified, 13 were included. Comfort-holding was studied in the context of end-of-life care, developmental care, mobilization, and as a unique intervention. Comfort-holding is common during end-of-life care with 77.8% of children held, but rare during acute management (51% of children < three years, < 5% of children ≥ three years). Commonly reported outcomes included child outcomes (e.g., physiologic measurements), safety outcomes (e.g., accidental line removal), parent outcomes (e.g., psychological symptoms), and frequency of holding. Conclusion There is a paucity of literature on comfort-holding in PICUs. This scoping review identifies significant gaps in the literature, including assessment of child-based outcomes of comfort-holding or safety assessment of comfort-holding, and highlights core outcomes to consider in future evaluations of this intervention including child-based outcomes, parent-based outcomes, and safety of the intervention. Supplementary Information The online version contains supplementary material available at 10.1007/s12630-021-02090-3.
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Affiliation(s)
- Laurie A Lee
- Department of Pediatrics, Cuming School of Medicine, University of Calgary, Calgary, AB, Canada. .,Faculty of Nursing, University of Calgary, Calgary, AB, Canada. .,Pediatric Intensive Care Unit, Alberta Children's Hospital Research Institute, University of Calgary, 28 Oki Drive, Calgary, AB, T3B 6A8, Canada.
| | - Stephana J Moss
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Critical Care Medicine, Alberta Health Services, Calgary, AB, Canada.,O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Dori-Ann Martin
- Department of Pediatrics, Cuming School of Medicine, University of Calgary, Calgary, AB, Canada.,Pediatric Intensive Care Unit, Alberta Children's Hospital Research Institute, University of Calgary, 28 Oki Drive, Calgary, AB, T3B 6A8, Canada
| | - Brianna K Rosgen
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Critical Care Medicine, Alberta Health Services, Calgary, AB, Canada.,O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Krista Wollny
- Faculty of Nursing, University of Calgary, Calgary, AB, Canada.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada
| | - Elaine Gilfoyle
- Department of Paediatrics, University of Toronto, Toronto, ON, Canada
| | - Kirsten M Fiest
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Department of Critical Care Medicine, Alberta Health Services, Calgary, AB, Canada.,O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada.,Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada.,Department of Psychiatry, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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23
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Bichard E, Wray J, Aitken LM. Discharged from paediatric intensive care: A mixed methods study of teenager's anxiety levels and experiences after paediatric intensive care unit discharge. Nurs Crit Care 2021; 27:429-439. [PMID: 34405487 DOI: 10.1111/nicc.12703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 07/16/2021] [Accepted: 08/04/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Teenagers represent a small proportion of patients on paediatric intensive care units (PICU) in the United Kingdom. During a time when their development is rapidly changing, an admission to PICU causes additional disruption. The impact of critical illness on psychological health after discharge has not been widely reported within this population. AIM AND OBJECTIVES To measure anxiety that teenagers report 48-96 hours and 4 weeks after discharge from PICU. To explore teenagers' experiences of being admitted onto PICU. DESIGN Two-phase mixed methods, explanatory sequential design. METHODS This single-site study was conducted between February and July 2018. An NHS Ethics committee approved the study. Teenagers were screened if they were aged 13-18 years old and had an elective or emergency admission to PICU for longer than 24 hours. Hospital Anxiety and Depression Scale, Anxiety subscale (HADS-A) was administered on paper and completed with the researcher present. Semi-structured interviews were conducted in-person and over the telephone, audio-recorded and transcribed verbatim. Data were analysed using inductive thematic analysis. RESULTS Nine of eighteen participants (50%) obtained scores indicating levels of anxiety which were mild (n = 3; 17%), moderate (n = 2; 11%), or severe (n = 4; 22%) 48-96 hours after PICU discharge. Four weeks later, all participants scored below the clinically significant cut-off level for the HADS-A-1 Teenagers described their experiences on PICU within three themes: Memories of treatments, side effects, and the PICU environment Losing a sense of self Feeling cared for CONCLUSIONS: Measured levels of anxiety had resolved in this small sample, 4 weeks after PICU discharge. This finding was not consistent with qualitative data that indicated that many experiences shared by participants were anxiety provoking. RELEVANCE TO CLINICAL PRACTICE Support for teenagers after PICU discharge should be available to meet individual needs; screening teenagers to identify support needs would be beneficial.
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Affiliation(s)
- Elizabeth Bichard
- London South Bank University, London, UK.,Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Jo Wray
- Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.,NIHR GOSH BRC, London, UK
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24
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Psychological Outcomes in Fathers of Critically Ill Children in the Pediatric Intensive Care Unit: A Systematic Review. J Clin Psychol Med Settings 2021; 29:249-261. [PMID: 34272639 DOI: 10.1007/s10880-021-09800-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/16/2021] [Indexed: 10/20/2022]
Abstract
Systematically review evidence of psychological distress in fathers of children admitted to the pediatric intensive care unit (PICU). Two reviewers independently reviewed 24 published articles that studied fathers during and closely following a PICU admission. Results are presented for psychological outcomes of stress, PTSD, anxiety and depression, family functioning, and other forms of distress. Potential moderators of distress are also presented. Although methodological variance and inconsistent findings make it difficult to draw definitive conclusions, mothers and fathers appear to experience similar levels of distress and psychiatric symptoms during and after a PICU admission. Fathers' distress may be characterized by feelings of helplessness and often manifests after discharge, later than for mothers. More research is needed to understand gender differences in the expression of parental distress during and after a PICU admission as this will serve to inform interventions designed to improve family functioning.
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25
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Bangirana P, Birabwa A, Nyakato M, Nakitende AJ, Kroupina M, Ssenkusu JM, Nakasujja N, Musisi S, John CC, Idro R. Use of the creating opportunities for parent empowerment programme to decrease mental health problems in Ugandan children surviving severe malaria: a randomized controlled trial. Malar J 2021; 20:267. [PMID: 34120616 PMCID: PMC8201864 DOI: 10.1186/s12936-021-03795-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 06/01/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Severe malaria is associated with long-term mental health problems in Ugandan children. This study investigated the effect of a behavioural intervention for caregivers of children admitted with severe malaria, on the children's mental health outcomes 6 months after discharge. METHODS This randomized controlled trial was conducted at Naguru Hospital in Kampala, Uganda from January 2018 to July 2019. Caregiver and child dyads were randomly assigned to either a psycho-educational arm providing information about hospital procedures during admission (control group), or to a behavioural arm providing information about the child's possible emotions and behaviour during and after admission, and providing age appropriate games for the caregiver and child (intervention group). Pre- and post-intervention assessments for caregiver anxiety and depression (Hopkins Symptom Checklist) and child mental health problems (Strength and Difficulties Questionnaire and the Child Behaviour Checklist) were done during admission and 6 months after discharge, respectively. T-tests, analysis of covariance, Chi-Square, and generalized estimating equations were used to compare outcomes between the two treatment arms. RESULTS There were 120 caregiver-child dyads recruited at baseline with children aged 1.45 to 4.89 years (mean age 2.85 years, SD = 1.01). The intervention and control groups had similar sociodemographic, clinical and behavioural characteristics at baseline. Caregiver depression at baseline, mother's education and female child were associated with behavioural problems in the child at baseline (p < 0.05). At 6 months follow-up, there was no difference in the frequency of behavioural problems between the groups (6.8% vs. 10% in intervention vs control groups, respectively, p = 0.72). Caregiver depression and anxiety scores between the treatment arms did not differ at 6 months follow-up. CONCLUSION This behavioural intervention for caregivers and their children admitted with severe malaria had no effect on the child's mental health outcomes at 6 months. Further studies need to develop interventions for mental health problems after severe malaria in children with longer follow-up time. Trail registration ClinicalTrials.gov Identifier: NCT03432039.
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Affiliation(s)
- Paul Bangirana
- Department of Psychiatry, Makerere University College of Health Sciences, Kampala, Uganda.
| | - Annet Birabwa
- Department of Mental Health and Community Psychology, Makerere University College of Humanities and Social Sciences, Kampala, Uganda
| | - Mary Nyakato
- Department of Psychiatry, Makerere University College of Health Sciences, Kampala, Uganda
| | - Ann J Nakitende
- Department of Psychiatry, Makerere University College of Health Sciences, Kampala, Uganda
| | - Maria Kroupina
- Department of Pediatrics, University of Minnesota, Minneapolis, MN, USA
| | - John M Ssenkusu
- Department of Epidemiology and Biostatistics, Makerere University College of Health Sciences, Kampala, Uganda
| | - Noeline Nakasujja
- Department of Psychiatry, Makerere University College of Health Sciences, Kampala, Uganda
| | - Seggane Musisi
- Department of Psychiatry, Makerere University College of Health Sciences, Kampala, Uganda
| | - Chandy C John
- Ryan White Center for Pediatric Infectious Disease and Global Health, Indiana University, Indianapolis, IN, USA
| | - Richard Idro
- Department of Pediatrics and Child Health, Makerere University College of Health Sciences, Kampala, Uganda
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26
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Meentken MG, van der Mheen M, van Beynum IM, Aendekerk EWC, Legerstee JS, van der Ende J, Del Canho R, Lindauer RJL, Hillegers MHJ, Helbing WA, Moll HA, Utens EMWJ. Long-term effectiveness of eye movement desensitization and reprocessing in children and adolescents with medically related subthreshold post-traumatic stress disorder: a randomized controlled trial. Eur J Cardiovasc Nurs 2021; 20:348-357. [PMID: 33709117 DOI: 10.1093/eurjcn/zvaa006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Revised: 09/09/2020] [Accepted: 10/03/2020] [Indexed: 11/12/2022]
Abstract
AIMS Medical procedures and hospitalizations can be experienced as traumatic and can lead to post-traumatic stress reactions. Eye movement desensitization and reprocessing (EMDR) shows promising results but very few long-term studies have been published. Therefore, our aim was to test the long-term (8 months post-treatment) effectiveness of EMDR in children and adolescents with medically related subthreshold post-traumatic stress disorder (PTSD). METHODS AND RESULTS Seventy-four children (including 39 with congenital or acquired heart disease) aged 4-15 (M = 9.6 years) with subthreshold PTSD after previous hospitalization were included into a parallel group randomized controlled trial. Participants were randomized to EMDR (n = 37) or care-as-usual (CAU) (n = 37; medical care only). The primary outcome was PTSD symptoms of the child. Secondary outcomes were symptoms of depression and blood-injection-injury (BII) phobia, sleep problems, and health-related quality of life (HrQoL) of the child. Assessments of all outcomes were planned at baseline and 8 weeks and 8 months after the start of EMDR/CAU. We hypothesized that the EMDR group would show significantly more improvements on all outcomes over time. Both groups showed improvements over time on child's symptoms of PTSD (only parent report), depression, BII phobia, sleep problems, and most HrQoL subscales. GEE analyses showed no significant differences between the EMDR group (nT2 = 33, nT3 = 30) and the CAU group (nT2 = 35, nT3 = 32) on the primary outcome. One superior effect of EMDR over time was found for reducing parent-reported BII phobia of the child. CONCLUSION EMDR did not perform better than CAU in reducing subthreshold PTSD up to 8 months post-treatment in previously hospitalized children. Possible explanations and clinical implications are discussed.
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Affiliation(s)
- Maya G Meentken
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Malindi van der Mheen
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Ingrid M van Beynum
- Division of Cardiology, Department of Pediatrics, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Elisabeth W C Aendekerk
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Jeroen S Legerstee
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Jan van der Ende
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Riwka Del Canho
- Department of Pediatrics, Maasstad Hospital, Rotterdam, The Netherlands
| | - Ramón J L Lindauer
- Academic Centre for Child and Adolescent Psychiatry the Bascule, Amsterdam, the Netherlands.,Department of Child and Adolescent Psychiatry, Amsterdam UMC, Location Academic Medical Center, Amsterdam, The Netherlands
| | - Manon H J Hillegers
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Willem A Helbing
- Division of Cardiology, Department of Pediatrics, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands.,Division of Cardiology, Department of Pediatrics, Radboud UMC-Amalia Children's Hospital, Nijmegen, The Netherlands
| | - Henriette A Moll
- Division of Pediatrics, Department of Pediatrics, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands
| | - Elisabeth M W J Utens
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC-Sophia Children's Hospital, Rotterdam, The Netherlands.,Academic Centre for Child and Adolescent Psychiatry the Bascule, Amsterdam, the Netherlands.,Department of Child and Adolescent Psychiatry, Amsterdam UMC, Location Academic Medical Center, Amsterdam, The Netherlands.,Research Institute of Child Development and Education, University of Amsterdam, Amsterdam, The Netherlands
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27
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Long-Term Outcomes and the Post-Intensive Care Syndrome in Critically Ill Children: A North American Perspective. CHILDREN-BASEL 2021; 8:children8040254. [PMID: 33805106 PMCID: PMC8064072 DOI: 10.3390/children8040254] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 03/17/2021] [Accepted: 03/20/2021] [Indexed: 12/14/2022]
Abstract
Advances in medical and surgical care for children in the pediatric intensive care unit (PICU) have led to vast reductions in mortality, but survivors often leave with newly acquired or worsened morbidity. Emerging evidence reveals that survivors of pediatric critical illness may experience a constellation of physical, emotional, cognitive, and social impairments, collectively known as the “post-intensive care syndrome in pediatrics” (PICs-P). The spectrum of PICs-P manifestations within each domain are heterogeneous. This is attributed to the wide age and developmental diversity of children admitted to PICUs and the high prevalence of chronic complex conditions. PICs-P recovery follows variable trajectories based on numerous patient, family, and environmental factors. Those who improve tend to do so within less than a year of discharge. A small proportion, however, may actually worsen over time. There are many gaps in our current understanding of PICs-P. A unified approach to screening, preventing, and treating PICs-P-related morbidity has been hindered by disparate research methodology. Initiatives are underway to harmonize clinical and research priorities, validate new and existing epidemiologic and patient-specific tools for the prediction or monitoring of outcomes, and define research priorities for investigators interested in long-term outcomes.
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28
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Meentken MG, van der Ende J, del Canho R, van Beynum IM, Aendekerk EWC, Legerstee JS, Lindauer RJL, Hillegers MHJ, Helbing WA, Moll HA, Utens EMWJ. Psychological outcomes after pediatric hospitalization: the role of trauma type. CHILDRENS HEALTH CARE 2021. [DOI: 10.1080/02739615.2021.1890077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Maya G Meentken
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC - Sophia Children’s Hospital, Rotterdam, The Netherlands
| | - Jan van der Ende
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC - Sophia Children’s Hospital, Rotterdam, The Netherlands
| | - Riwka del Canho
- Department of Pediatrics, Maasstad Hospital, Rotterdam, The Netherlands
| | - Ingrid M. van Beynum
- Department of Pediatrics, Division of Cardiology, Erasmus MC – Sophia Children’s Hospital, Rotterdam, The Netherlands
| | - Elisabeth W. C. Aendekerk
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC - Sophia Children’s Hospital, Rotterdam, The Netherlands
| | - Jeroen S. Legerstee
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC - Sophia Children’s Hospital, Rotterdam, The Netherlands
| | - Ramón J. L. Lindauer
- de Bascule, Academic Center for Child and Adolescent Psychiatry, Amsterdam, The Netherlands
- Department of Child and Adolescent Psychiatry, Amsterdam UMC, Location Academic Medical Center, Amsterdam, The Netherlands
| | - Manon H. J. Hillegers
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC - Sophia Children’s Hospital, Rotterdam, The Netherlands
| | - Willem A. Helbing
- Department of Pediatrics, Division of Cardiology, Erasmus MC – Sophia Children’s Hospital, Rotterdam, The Netherlands
- Department of Pediatrics, Division of Cardiology, Radboud UMC – Amalia Children’s Hospital, Nijmegen, The Netherlands
| | - Henriette A. Moll
- Department of Pediatrics, Division of General Pediatrics, Erasmus MC – Sophia Children’s Hospital, Rotterdam, The Netherlands
| | - Elisabeth M. W. J. Utens
- Department of Child and Adolescent Psychiatry/Psychology, Erasmus MC - Sophia Children’s Hospital, Rotterdam, The Netherlands
- de Bascule, Academic Center for Child and Adolescent Psychiatry, Amsterdam, The Netherlands
- Department of Child and Adolescent Psychiatry, Amsterdam UMC, Location Academic Medical Center, Amsterdam, The Netherlands
- Research Institute of Child Development and Education, University of Amsterdam, Amsterdam, The Netherlands
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29
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Corsi M, Orsini A, Pedrinelli V, Santangelo A, Bertelloni CA, Carli N, Buselli R, Peroni D, Striano P, Dell'Osso L, Carmassi C. PTSD in parents of children with severe diseases: a systematic review to face Covid-19 impact. Ital J Pediatr 2021; 47:8. [PMID: 33446246 PMCID: PMC7807213 DOI: 10.1186/s13052-021-00957-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Accepted: 01/04/2021] [Indexed: 11/10/2022] Open
Abstract
CONTEXT The literature agrees on the impact of post-traumatic stress symptoms in parents of seriously ill children but there is less clarity about the real extent and gender differences of this psychopathological risk. The recent Covid-19 outbreak highlighted new burdens for researchers on Post Traumatic Stress Disorder (PTSD) and clear evidence-based knowledge on this issue is timely needed. OBJECTIVE In this review, we present a synthesis of the updated evidence on PTSD rates in parents of children with severe diseases. We also aim to try to understand if research in this field has been refined over time with the long-term intent to better face the new challenges of Covid-19 in the paediatric field. DATA SOURCES The PubMed database was searched. STUDY SELECTION Studies were included if they assessed PTSD in parents of children diagnosed with physical illnesses. DATA EXTRACTION Of 240 studies, 4 were included. RESULTS Analysis of the 4 studies revealed 2 studies with PTSD rates around 20% and in line with previous best-evidence. All 4 studies tried to provide more data on fathers, however, all the studies present the lack of a control group. LIMITATIONS The limited number of studies, which also differ widely in the methodology used. CONCLUSIONS Methodological errors evidenced in all the 4 studies limit their reliability, making the understanding of the paediatric caregiver's concern regarding PTSD still difficult. More sound research is needed.
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Affiliation(s)
- Martina Corsi
- Department of Clinical and Experimental Medicine, Psychiatric Clinic, Azienda Ospedaliero-Universitaria Pisana, University of Pisa, Pisa, Italy
- Occupational Health Department, Azienda Ospedaliero-Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Alessandro Orsini
- Department of Clinical and Experimental Medicine, Pediatric Clinic, Azienda Ospedaliero-Universitaria Pisana, University of Pisa, Pisa, Italy.
- Pediatric Neurology, Pediatric Department, Azienda Ospedaliero- Universitaria Pisana, University of Pisa, Pisa, Italy.
| | - Virginia Pedrinelli
- Department of Clinical and Experimental Medicine, Psychiatric Clinic, Azienda Ospedaliero-Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Andrea Santangelo
- Department of Clinical and Experimental Medicine, Pediatric Clinic, Azienda Ospedaliero-Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Carlo Antonio Bertelloni
- Department of Clinical and Experimental Medicine, Psychiatric Clinic, Azienda Ospedaliero-Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Niccolò Carli
- Department of Clinical and Experimental Medicine, Pediatric Clinic, Azienda Ospedaliero-Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Rodolfo Buselli
- Occupational Health Department, Azienda Ospedaliero-Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Diego Peroni
- Department of Clinical and Experimental Medicine, Pediatric Clinic, Azienda Ospedaliero-Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Pasquale Striano
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Genoa, Italy
- Pediatric Neurology and Muscular Diseases Unit, IRCCS Istituto Giannina Gaslini, Genoa, Italy
| | - Liliana Dell'Osso
- Department of Clinical and Experimental Medicine, Psychiatric Clinic, Azienda Ospedaliero-Universitaria Pisana, University of Pisa, Pisa, Italy
| | - Claudia Carmassi
- Department of Clinical and Experimental Medicine, Psychiatric Clinic, Azienda Ospedaliero-Universitaria Pisana, University of Pisa, Pisa, Italy
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30
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Rennick JE, Knox AM, Treherne SC, Dryden-Palmer K, Stremler R, Chambers CT, McRae L, Ho M, Stack DM, Dougherty G, Fudge H, Campbell-Yeo M. Family Members' Perceptions of Their Psychological Responses One Year Following Pediatric Intensive Care Unit (PICU) Hospitalization: Qualitative Findings From the Caring Intensively Study. Front Pediatr 2021; 9:724155. [PMID: 34557460 PMCID: PMC8452961 DOI: 10.3389/fped.2021.724155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Accepted: 08/06/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: PICU hospitalization can have a profound impact on child survivors and their families. There is limited research on children's long-term recovery within the context of the family following critical illness. This study aimed to explore children's and parents' perceptions of long-term psychological and behavioral responses within the context of the family one year following PICU hospitalization. Materials and Methods: Caring Intensively is a mixed methods multi-site prospective cohort study that aims to examine children's psychological and behavioral responses over a 3-year period following PICU hospitalization. In this study, part of the qualitative arm of Caring Intensively, an interpretive descriptive design was used to explore children's recovery one year post-discharge. Purposive sampling was used to select 17 families, including 16 mothers, 6 fathers, and 9 children. Semi-structured, audio-recorded interviews were conducted. Data were analyzed iteratively using the constant comparison method. Results: Families described efforts to readapt to routine life and find a new normal following PICU hospitalization. Finding a New Normal consisted of four major themes: (1) Processing PICU Reminders and Memories, (2) Changing Perceptions of Health and Illness, (3) We Are Not the Same, and (4) Altered Relationships. Participants described significant emotional and behavioral changes during the year following discharge. The psychological impact of individual family members' experiences led to changes in their sense of self, which affected family dynamics. PICU memories and reminders impacted participants' perceptions of childhood health and illness and resulted in increased vigilance. Parents and siblings demonstrated increased concern for the child survivor's health, and the experience of long absences and new or altered caregiving roles resulted in changes in relationships and family dynamics. Conclusion: PICU hospitalization impacted the psychological well-being of all family members as they sought to re-establish a sense of normalcy one year following discharge. Parent and child experiences and responses were closely interconnected. Findings highlight the importance of increased follow-up care aimed at supporting the family's psychological recovery.
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Affiliation(s)
- Janet E Rennick
- Department of Nursing, The Montreal Children's Hospital, McGill University Health Centre (MUHC), Montreal, QC, Canada.,Ingram School of Nursing, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada.,Department of Pediatrics, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada.,Child Health and Human Development, Research Institute of the MUHC, Montreal, QC, Canada
| | - Alyssa M Knox
- Child Health and Human Development, Research Institute of the MUHC, Montreal, QC, Canada
| | - Stephanie C Treherne
- Child Health and Human Development, Research Institute of the MUHC, Montreal, QC, Canada
| | - Karen Dryden-Palmer
- Department of Critical Care, Hospital for Sick Children, Toronto, ON, Canada.,Child Health Evaluative Sciences, Research Institute, Hospital for Sick Children, Toronto, ON, Canada
| | - Robyn Stremler
- Child Health Evaluative Sciences, Research Institute, Hospital for Sick Children, Toronto, ON, Canada.,Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
| | - Christine T Chambers
- Department of Psychology and Neuroscience and Department of Pediatrics, Dalhousie University, Halifax, NS, Canada
| | - Lyndsey McRae
- Department of Neurosciences and Trauma, Hospital for Sick Children, Toronto, ON, Canada
| | - Michelle Ho
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada.,Division of Paediatric Medicine, Complex Care Program, Hospital for Sick Children, Toronto, ON, Canada
| | - Dale M Stack
- Department of Psychology and Centre for Research in Human Development, Concordia University, Montreal, QC, Canada
| | - Geoffrey Dougherty
- Department of Pediatrics, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada.,Child Health and Human Development, Research Institute of the MUHC, Montreal, QC, Canada.,Department of Epidemiology and Biostatistics, Faculty of Medicine and Health Sciences, McGill University, Montreal, QC, Canada
| | - Hailey Fudge
- School of Nursing, Faculty of Health, Dalhousie University, Halifax, NS, Canada
| | - Marsha Campbell-Yeo
- School of Nursing, Faculty of Health, Dalhousie University, Halifax, NS, Canada.,Department of Nursing and Department of Pediatrics, IWK Health, Halifax, NS, Canada
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31
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Dow B, Kenardy J, Long D, Le brocque R. Children's post‐traumatic stress and the role of memory following admission to intensive care: A review. CLIN PSYCHOL-UK 2020. [DOI: 10.1111/j.1742-9552.2012.00040.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Belinda Dow
- Centre of National Research on Disability and Rehabilitation Medicine, School of Medicine
- School of Psychology, University of Queensland, Brisbane
| | - Justin Kenardy
- Centre of National Research on Disability and Rehabilitation Medicine, School of Medicine
- School of Psychology, University of Queensland, Brisbane
| | - Deborah Long
- Paediatric Intensive Care Unit, Royal Children's Hospital, Brisbane, Queensland, Australia
| | - Robyne Le brocque
- Centre of National Research on Disability and Rehabilitation Medicine, School of Medicine
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32
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Logan GE, Sahrmann JM, Gu H, Hartman ME. Parental Mental Health Care After Their Child's Pediatric Intensive Care Hospitalization. Pediatr Crit Care Med 2020; 21:941-948. [PMID: 32947380 PMCID: PMC7609586 DOI: 10.1097/pcc.0000000000002559] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVES Post-traumatic stress disorder, depression, and anxiety have all been found in parents of PICU survivors. How these research findings translate to actual use of mental health services by parents remains unknown. DESIGN Retrospective observational cohort study. SETTING Insurance claims data from 2006 to 2013 obtained from the IBM MarketScan Commercial Database. PATIENTS Parents of PICU survivors. INTERVENTIONS We examined rates of: 1) mental health diagnoses, 2) outpatient mental health visits, and 3) prescriptions for antidepressants and anxiolytics among parents, 6 months before and 6 months after their child's PICU admission, using each parent as their own control. MEASUREMENTS AND MAIN RESULTS Of the 95,070 parents identified, 9.5% received a new mental health diagnosis in the 6 months after their child's PICU hospitalization, which represented a 110% increase from pre-PICU rates. A smaller proportion of parents were given new prescriptions for antidepressants (3.4%) and anxiolytics (3.9%) in the 6 months after their child's PICU hospitalization. Mothers were twice as likely to receive a new mental health diagnosis and be taking a new medication than fathers in the post-PICU period. The parental diagnosis of acute stress disorder or post-traumatic stress disorder increased by 87% from the pre-PICU to the post-PICU period. CONCLUSIONS After their child's PICU hospitalization, the proportion of parents with a new mental health diagnosis nearly doubled. Mothers were at nearly twice the risk of receiving a new mental health diagnosis and receiving a new mental health medication compared with fathers. The proportion of parents receiving mental healthcare is much lower than the proportion reporting mental health symptoms in long-term outcomes studies. Whether this indicates a gap in healthcare delivery for parents with mental health symptoms remains unknown.
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Affiliation(s)
- Grace E. Logan
- Department of Pediatrics, Washington University in St. Louis, St. Louis, MO
| | - John M. Sahrmann
- Department of Medicine, Division of Infectious Diseases, Washington University in St. Louis, St. Louis, MO
| | - Hongjie Gu
- Division of Biostatistics, Washington University in St. Louis, St. Louis, MO
| | - Mary E. Hartman
- Department of Pediatrics, Washington University in St. Louis, St. Louis, MO
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33
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Mikkonen ED, Skrifvars MB, Reinikainen M, Bendel S, Laitio R, Hoppu S, Ala-Kokko T, Karppinen A, Raj R. Psychotropic Medication After Intensive Care Unit-Treated Pediatric Traumatic Brain Injury. Pediatr Neurol 2020; 112:64-70. [PMID: 32916426 DOI: 10.1016/j.pediatrneurol.2020.05.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 04/27/2020] [Accepted: 05/02/2020] [Indexed: 11/15/2022]
Abstract
BACKGROUND Our aim was to assess the occurrence and risk factors for psychotropic medication use after pediatric traumatic brain injury treated in the intensive care unit. METHODS We combined data from the Finnish Intensive Care Consortium database, data on reimbursed medications from the Social Insurance Institute, and individual electronic health care data. We analyzed data on children aged five to 17 years treated for traumatic brain injury in intensive care units of four university hospitals in Finland during 2003 to 2013 and being alive six months after injury with no history of psychotropic medication use before traumatic brain injury. RESULTS We identified 248 patients of whom 46 (19%) were prescribed a new psychotropic medication after traumatic brain injury. In multivariable logistic regression, a higher age associated with a higher probability for use of any psychotropic medication. Subgroup analyses showed that higher age associated with an increased risk of antidepressant and antipsychotic use but with a decreased risk of stimulant use. Apart from age, we found no other clinical, radiological, or treatment-related factors that significantly associated with subsequent use of psychotropics. Psychotropic medication was most common (45%) in children aged 12 to 17 years and had moderate disability at six-month follow-up. CONCLUSIONS One fifth of children treated in the intensive care unit for traumatic brain injury were prescribed a new psychotropic medication during a median follow-up of three years and five months. Psychotropic medication was most common among teenagers with moderate post-traumatic disability. The need and use of psychotropics postinjury seem multifactorial and not related to any traumatic brain injury type.
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Affiliation(s)
- Era D Mikkonen
- Department of Anesthesiology, Intensive Care and Pain Medicine, Helsinki University Hospital, University of Helsinki, Helsinki, Finland; Department of Emergency Care and Services, Helsinki University Hospital, University of Helsinki, Helsinki, Finland.
| | - Markus B Skrifvars
- Department of Emergency Care and Services, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Matti Reinikainen
- Department of Anesthesiology and Intensive Care, Kuopio University Hospital, University of Eastern Finland, Kuopio, Finland
| | - Stepani Bendel
- Department of Anesthesiology and Intensive Care, Kuopio University Hospital, University of Eastern Finland, Kuopio, Finland
| | - Ruut Laitio
- Department of Intensive Care, Turku University Hospital, University of Turku, Turku, Finland
| | - Sanna Hoppu
- Emergency Medical Services, Tampere University Hospital, Tampere University, Tampere, Finland; Department of Intensive Care, Tampere University Hospital, Tampere University, Tampere, Finland
| | - Tero Ala-Kokko
- Division of Intensive Care, Oulu University Hospital, University of Oulu, Oulu, Finland; Medical Research Center Oulu MRC, Research group of Anesthesiology, Surgery and Intensive Care Medicine, University of Oulu, Oulu, Finland
| | - Atte Karppinen
- Department of Neurosurgery, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
| | - Rahul Raj
- Department of Neurosurgery, Helsinki University Hospital, University of Helsinki, Helsinki, Finland
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Longitudinal Trajectories of Caregiver Distress and Family Functioning After Community-Acquired Pediatric Septic Shock. Pediatr Crit Care Med 2020; 21:787-796. [PMID: 32541376 PMCID: PMC9125433 DOI: 10.1097/pcc.0000000000002404] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVES To identify trajectories and correlates of caregiver distress and family functioning in families of children who survived community-acquired septic shock. We hypothesized that: 1) a substantial subset of families would demonstrate trajectories of persistent elevated caregiver distress and impaired family functioning 12 months after hospitalization and 2) sociodemographic and clinical risk factors would be associated with trajectories of persistent distress and family dysfunction. DESIGN Prospective cohort. SETTING Fourteen PICUs in the United States. PATIENTS Caregivers of 260 children who survived community-acquired septic shock. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Caregivers completed ratings of distress on the Brief Symptom Inventory and of family functioning on the Family Assessment Device at baseline, 1, 3, 6, and 12 months after hospitalization. Results from group-based trajectory modeling indicated that 67% of the current sample was characterized by persistent low caregiver distress, 26% by persistent moderate to high distress that remained stable across 12 months (high-risk caregiver distress group), and 8% by initial high distress followed by gradual recovery. Forty percent of the sample was characterized by stable high family functioning, 15% by persistent high dysfunction across 12 months (high-risk family functioning group), 12% by gradually improving functioning, and 32% by deteriorating function over time. Independently of age, child race was associated with membership in the high-risk caregiver distress group (non-white/Hispanic; effect size, -0.12; p = 0.010). There were no significant sociodemographic or clinical correlates of the high-risk family functioning group in multivariable analyses. CONCLUSIONS Although the majority of families whose children survived community-acquired septic shock were characterized by resilience, a subgroup demonstrated trajectories of persistently elevated distress and family dysfunction during the 12 months after hospitalization. Results suggest a need for family-based psychosocial screening after pediatric septic shock to identify and support at-risk families.
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Lehman LL, Maletsky K, Beaute J, Rakesh K, Kapur K, Rivkin MJ, Mrakotsky C. Prevalence of Symptoms of Anxiety, Depression, and Post-traumatic Stress Disorder in Parents and Children Following Pediatric Stroke. J Child Neurol 2020; 35:472-479. [PMID: 32202201 DOI: 10.1177/0883073820909617] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Post-traumatic stress disorder (PTSD), anxiety, and depression are seen in parents and children following critical illness. Whether this exists in parents and children following pediatric stroke has not been thoroughly studied. We examined emotional outcomes in 54 mothers, 27 fathers, and 17 children with stroke. Parents of children 0-18 years and children 7-18 years who were within 2 years of stroke occurrence were asked to complete questionnaires to determine their emotional outcomes. Of participating mothers, 28% reported PTSD, 26% depression, and 4% anxiety; in fathers, 15% reported PTSD, 24% depression, and none reported anxiety. Further, children reported significant emotional difficulty, with 24% having depression, 14% anxiety, and 6% PTSD by self-report ratings. Maternal PTSD, anxiety and depression, and paternal anxiety were all negatively associated with the child's functional outcome. Clinically significant anxiety (based on clinical thresholds) was not found in fathers; however, continuous scores were still analyzed for association between subclinical anxiety and functional outcome, which revealed a statistically significant association between more reported symptoms and higher Recovery and Recurrence Questionnaire scores. Prevalence of PTSD and depression are greater in parents compared to the general population in this preliminary study.
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Affiliation(s)
- Laura L Lehman
- Department of Neurology, Boston Children's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Kristin Maletsky
- Department of Neurology, Boston Children's Hospital, Boston, MA, USA
| | - Jeanette Beaute
- Department of Neurology, Boston Children's Hospital, Boston, MA, USA
| | - Kshitiz Rakesh
- Department of Neurology, Boston Children's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Kush Kapur
- Department of Neurology, Boston Children's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Michael J Rivkin
- Department of Neurology, Boston Children's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA.,Department of Psychiatry, Boston Children's Hospital, Boston, MA, USA.,Department of Radiology Boston Children's Hospital, Boston, MA, USA
| | - Christine Mrakotsky
- Department of Neurology, Boston Children's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA.,Department of Psychiatry, Boston Children's Hospital, Boston, MA, USA
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Associations between Infant and Parent Characteristics and Measures of Family Well-Being in Neonates with Seizures: A Cohort Study. J Pediatr 2020; 221:64-71.e4. [PMID: 32446494 PMCID: PMC7336525 DOI: 10.1016/j.jpeds.2020.02.024] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 01/29/2020] [Accepted: 02/12/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To characterize and determine risk factors for key dimensions of well-being at hospital discharge in families of neonates with acute symptomatic seizures. STUDY DESIGN This prospective, observational cohort study enrolled 144 parent-infant dyads among neonates with acute symptomatic seizures from 9 pediatric hospitals in the Neonatal Seizure Registry. One parent per family completed a discharge survey, which included measures of anxiety and depression, health-related quality of life, and impact on the family. Multivariable regression analyses adjusted for site were constructed to examine parent and infant characteristics associated with well-being. RESULTS At discharge, 54% of parents reported symptoms of anxiety and 32% reported symptoms of depression. Parents of infants with hypoxic-ischemic encephalopathy reported more depression and worse quality of life than parents of infants with other seizure etiologies. Parental quality of life was also lower with greater infant age at discharge. A higher level of maternal education was associated with greater impact on the family. All these differences were medium to large effect sizes, ranging from 0.52 to 0.78. CONCLUSIONS Symptoms of anxiety and depression are common in parents of infants with neonatal seizures, and several parent and infant characteristics are associated with poorer parental quality of life and family well-being. These findings are a call to action to improve mental health screening and services for parents of infants with neonatal seizures.
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Manning JC, Latour JM, Curley MAQ, Draper ES, Jilani T, Quinlan PR, Watson RS, Rennick JE, Colville G, Pinto N, Latif A, Popejoy E, Coad J. Study protocol for a multicentre longitudinal mixed methods study to explore the Outcomes of ChildrEn and fAmilies in the first year after paediatric Intensive Care: the OCEANIC study. BMJ Open 2020; 10:e038974. [PMID: 32423943 PMCID: PMC7239532 DOI: 10.1136/bmjopen-2020-038974] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 04/16/2020] [Accepted: 04/21/2020] [Indexed: 01/18/2023] Open
Abstract
INTRODUCTION Annually in the UK, 20 000 children become very ill or injured and need specialist care within a paediatric intensive care unit (PICU). Most children survive. However, some children and their families may experience problems after they have left the PICU including physical, functional and/or emotional problems. It is unknown which children and families experience such problems, when these occur or what causes them. The aim of this mixed-method longitudinal cohort study is to understand the physical, functional, emotional and social impact of children surviving PICU (aged: 1 month-17 years), their parents and siblings, during the first year after a PICU admission. METHODS AND ANALYSIS A quantitative study involving 300 child survivors of PICU; 300 parents; and 150-300 siblings will collect data (using self-completion questionnaires) at baseline, PICU discharge, 1, 3, 6 and 12 months post-PICU discharge. Questionnaires will comprise validated and reliable instruments. Demographic data, PICU admission and treatment data, health-related quality of life, functional status, strengths and difficulties behaviour and post-traumatic stress symptoms will be collected from the child. Parent and sibling data will be collected on the impact of paediatric health conditions on the family's functioning capabilities, levels of anxiety and social impact of the child's PICU admission. Data will be analysed using descriptive and inferential statistics. Concurrently, an embedded qualitative study involving semistructured interviews with 24 enrolled families at 3 months and 9 months post-PICU discharge will be undertaken. Framework analysis will be used to analyse the qualitative data. ETHICS AND DISSEMINATION The study has received ethical approval from the National Health Services Research Ethics Committee (Ref: 19/WM/0290) and full governance clearance. This will be the first UK study to comprehensively investigate physical, functional, emotional and social consequences of PICU survival in the first-year postdischarge.Clinical Trials Registration Number: ISRCTN28072812 [Pre-results].
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Affiliation(s)
- Joseph C Manning
- Children and Young People Health Research, School of Health Sciences, University of Nottingham, Nottingham, Nottinghamshire, UK
- Nottingham Children's Hospital, Nottingham University Hospitals NHS Trust, Nottingham, Nottinghamshire, UK
- Health Data Research UK, University of Nottingham, Nottingham, Nottinghamshire, UK
| | - Jos M Latour
- School of Nursing and Midwifery, University of Plymouth, Plymouth, UK
- Nursing Department, Hunan Children's Hospital, Changsha, Hunan, China
| | - Martha A Q Curley
- Department of Family and Community Health, School of Nursing, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Anesthesia and Critical Care Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- The Research Institute, Children's Hospital of Philadelphia, Philadelphia, PA, USA
| | - Elizabeth S Draper
- Department of Health Sciences, University of Leicester, Leicester, Leicestershire, UK
| | - Tahseen Jilani
- Health Data Research UK, University of Nottingham, Nottingham, Nottinghamshire, UK
- Advanced Data Analysis Centre, University of Nottingham, Nottingham, Nottinghamshire, UK
| | - Philip R Quinlan
- Health Data Research UK, University of Nottingham, Nottingham, Nottinghamshire, UK
- Advanced Data Analysis Centre, University of Nottingham, Nottingham, Nottinghamshire, UK
| | - R Scott Watson
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, University of Washington, Seattle, Washington, USA
- Centre for Child Health, Behaviour, and Development, Seattle Children's Research Institute, Seattle, Washington, USA
| | - Janet E Rennick
- Ingram School of Nursing, McGill University Faculty of Medicine, Montreal, Quebec, Canada
- Centre for Outcomes Research & Evaluation, Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Gillian Colville
- Paediatric Psychology Service, St Georges University Hospitals NHS Foundation Trust, London, UK
- Population Health Research Institute, University of London St George's, London, UK
| | - Neethi Pinto
- Section of Pediatric Critical Care, Department of Pediatrics, University of Chicago, Chicago, Illinois, USA
| | - Asam Latif
- School of Health Sciences, University of Nottingham, Nottingham, Nottinghamshire, UK
| | - Emma Popejoy
- Children and Young People Health Research, School of Health Sciences, University of Nottingham, Nottingham, Nottinghamshire, UK
- Nottingham Children's Hospital, Nottingham University Hospitals NHS Trust, Nottingham, Nottinghamshire, UK
| | - Jane Coad
- Children and Young People Health Research, School of Health Sciences, University of Nottingham, Nottingham, Nottinghamshire, UK
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Atkins EK, John M, Colville G. Families' Experiences of Life in the Year after a Child's Critical Illness: Navigating the Road to a "New Normal". J Pediatr Intensive Care 2020; 9:188-195. [PMID: 32685246 DOI: 10.1055/s-0040-1705132] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 01/29/2020] [Indexed: 01/20/2023] Open
Abstract
Semistructured interviews were conducted with patients and family members ( n = 18) postdischarge to examine how they managed their recovery in the year following a child's intensive care unit admission. Data were analyzed using the grounded theory. Participants described an ongoing need to develop and adapt their narratives about admission and recovery. Other key themes were as follows: just getting through, recognizing they had changed, striving for normality, and finding positive aspects related to their experiences. It took longer than they expected for families to build a coherent narrative of events postdischarge and to adjust to the "new normal." Implications for health professionals are discussed.
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Affiliation(s)
- Ellie K Atkins
- Paediatric Psychology Service, St. George's University Hospital, London, United Kingdom
| | - Mary John
- School of Psychology, University of Surrey, Surrey, United Kingdom
| | - Gillian Colville
- Paediatric Psychology Service, St. George's University Hospital, London, United Kingdom
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Provider Consensus on Candidate Protective and Risk Factors for Adverse Psychosocial Outcomes Following Discharge From a PICU: A Modified Delphi Study. Pediatr Crit Care Med 2020; 21:e1-e7. [PMID: 31651723 DOI: 10.1097/pcc.0000000000002158] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Pediatric palliative care promotes interdisciplinary, family-centered care when children are faced with diagnoses threatening length and/or quality of life. A significant knowledge gap remains in how to best match pediatric palliative care resources to palliate the psychosocial impact of a PICU admission. This study was designed to identify drivers of adverse post-PICU psychosocial outcomes related to social determinants of health to inform pediatric palliative care services and improve post-PICU psychosocial outcomes. DESIGN Modified Delphi technique to develop consensus regarding social determinants of health and clinical factors affecting post-ICU psychosocial outcomes. SETTING All Delphi rounds were via an electronically mailed survey link. SUBJECTS First-round participants were PICU and pediatric palliative care clinicians at the study institution. Subsequent rounds invited participants from national PICU and pediatric palliative care professional online listserves. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Consensus was defined a priori as items assigned a score greater than or equal to 4 (5-point scale) by greater than75% of respondents. One-hundred twenty-six surveys were returned and scored. Social determinants of health risk factors included child protective services involvement (91%), caregiver with intellectual disability (87%), lack of friend or family support (82%), caregiver with behavioral health diagnosis (81%), teenage caregiver (79%), transportation challenges (79%), and language/cultural barrier (76%). Clinical risk factors included new home ventilator (94%), new tracheostomy (90%), greater than or equal to 3 hospitalizations in the prior 6 months (88%), and greater than or equal to 3 hospitalizations in the prior 12 months (82%). Social determinants of health protective factors included extended family support (91%), caregivers in a committed relationship (79%), and caregiver optimism (78%). Respondents reported that pediatric palliative care services had the greatest impact on caregiver satisfaction with the healthcare system (90%) and increased family involvement with state social services programs (80%). CONCLUSIONS Consensus on candidate risk and protective factors for post-ICU psychosocial challenges and candidate pediatric palliative care-sensitive variables were identified. Further research is needed to operationalize and optimize a screening tool based on these consensus items and test it prospectively.
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Strengths and Difficulties Questionnaire Assessment of Long-Term Psychological Outcome in Children After Intensive Care Admission. Pediatr Crit Care Med 2019; 20:e496-e502. [PMID: 31274777 DOI: 10.1097/pcc.0000000000002078] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVES We investigated the long-term psychologic symptoms of patients who survived pediatric intensive care admission. DESIGN Longitudinal follow-up study. SETTING Nationwide cohort study based on a national ICU register and a questionnaire survey. PATIENTS All pediatric patients (0-16 yr old) who were admitted to an ICU in Finland in 2009-2010. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Six years after ICU admission, all surviving patients were sent the Strengths and Difficulties Questionnaire, and questionnaires regarding chronic diseases and need for medication and therapy. At the end of the follow-up period, there were 3,674 surviving children who had been admitted to an ICU in 2009-2010. Of these children, 1,105 completed the Strengths and Difficulties Questionnaire 6 years after admission. Strengths and Difficulties Questionnaire scores were abnormal for 84 children (7.6%), borderline for 80 (7.2%), and normal for 941 (85.2%). Participants with abnormal scores were younger at admission to the ICU (3.06 vs 4.70 yr; p = 0.02), and more commonly had a chronic disease (79.5% vs 47.4%; p < 0.001), a need for continuous medication (49.4% vs 31.7%; p < 0.001), a need for therapy (58.5% vs 15.9%; p < 0.001), and a need for annual healthcare visits (91.4% vs 85.2%; p = 0.05). Abnormal Strengths and Difficulties Questionnaire scores were associated with higher rates of neurologic (32.1% vs 10.2%), gastrointestinal (7.1% vs 3.9%), psychiatric (3.6% vs 0.5%), and chromosomal disorders (9.5% vs 1.3%), as well as with long-term pain (1.2% vs 0.6%). CONCLUSIONS Participants with abnormal Strengths and Difficulties Questionnaire scores (poor psychologic outcome) at 6 years after childhood ICU admission more commonly suffered neurologic, chromosomal, or psychiatric diagnoses or long-term pain, and generally required higher levels of healthcare services, therapies, and medication.
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Williams CN, Hartman ME, Guilliams KP, Guerriero RM, Piantino JA, Bosworth CC, Leonard SS, Bradbury K, Wagner A, Hall TA. Postintensive Care Syndrome in Pediatric Critical Care Survivors: Therapeutic Options to Improve Outcomes After Acquired Brain Injury. Curr Treat Options Neurol 2019; 21:49. [PMID: 31559490 DOI: 10.1007/s11940-019-0586-x] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
PURPOSE OF REVIEW Children surviving the pediatric intensive care unit (PICU) with neurologic illness or injury have long-term morbidities in physical, cognitive, emotional, and social functioning termed postintensive care syndrome (PICS). In this article, we review acute and longitudinal management strategies available to combat PICS in children with acquired brain injury. RECENT FINDINGS Few intervention studies in this vulnerable population target PICS morbidities. Small studies show promise for both inpatient- and outpatient-initiated therapies, mainly focusing on a single domain of PICS and evaluating heterogeneous populations. While evaluating the effects of interventions on longitudinal PICS outcomes is in its infancy, longitudinal clinical programs targeting PICS are increasing. A multidisciplinary team with inpatient and outpatient presence is necessary to deliver the holistic integrated care required to address all domains of PICS in patients and families. While PICS is increasingly recognized as a chronic problem in PICU survivors with acquired brain injury, few interventions have targeted PICS morbidities. Research is needed to improve physical, cognitive, emotional, and social outcomes in survivors and their families.
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Affiliation(s)
- Cydni N Williams
- Pediatric Critical Care and Neurotrauma Recovery Program, Oregon Health and Science University, 707 SW Gaines St., CDRC-P, Portland, OR, 97239, USA.
- Department of Pediatrics, Division of Pediatric Critical Care, Oregon Health and Science University, Portland, OR, USA.
| | - Mary E Hartman
- Department of Pediatrics, Division of Critical Care Medicine, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, MO, USA
| | - Kristin P Guilliams
- Department of Pediatrics, Division of Critical Care Medicine, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, MO, USA
- Department of Neurology, Division of Pediatric and Developmental Neurology, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, MO, USA
| | - Rejean M Guerriero
- Department of Neurology, Division of Pediatric and Developmental Neurology, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, MO, USA
| | - Juan A Piantino
- Pediatric Critical Care and Neurotrauma Recovery Program, Oregon Health and Science University, 707 SW Gaines St., CDRC-P, Portland, OR, 97239, USA
- Department of Pediatrics, Division of Pediatric Neurology, Oregon Health and Science University, Portland, OR, USA
| | - Christopher C Bosworth
- Department of Psychology, Washington University School of Medicine, St. Louis Children's Hospital, St. Louis, MO, USA
| | - Skyler S Leonard
- Department of Pediatrics, Division of Pediatric Psychology, Oregon Health and Science University, Portland, OR, USA
| | - Kathryn Bradbury
- Department of Pediatrics, Division of Pediatric Psychology, Oregon Health and Science University, Portland, OR, USA
| | - Amanda Wagner
- Department of Pediatrics, Division of Pediatric Psychology, Oregon Health and Science University, Portland, OR, USA
| | - Trevor A Hall
- Pediatric Critical Care and Neurotrauma Recovery Program, Oregon Health and Science University, 707 SW Gaines St., CDRC-P, Portland, OR, 97239, USA
- Department of Pediatrics, Division of Pediatric Psychology, Oregon Health and Science University, Portland, OR, USA
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Esses SA, Small S, Rodemann A, Hartman ME. Post-Intensive Care Syndrome: Educational Interventions for Parents of Hospitalized Children. Am J Crit Care 2019; 28:19-27. [PMID: 30600223 DOI: 10.4037/ajcc2019151] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND Targeted education to help parents and caregivers recognize the signs and symptoms of post-intensive care syndrome may increase their awareness and willingness to seek support during their child's admission. The optimal strategy for this education has not been established. METHODS A pilot study to test 3 educational strategies for caregivers of pediatric intensive care unit patients. The 3 strategies were compared using the Practical, Robust Implementation and Sustainability Model framework for effectiveness of the education, the effect of each educational intervention on the intensive care unit nursing environment, and costs. Nursing responses were scored on a 3-point Likert scale. RESULTS A total of 62 caregivers randomly received 1 of 3 educational strategies: brochures (n = 22), scripted conversation (n = 20), or a 3-minute video (n = 20). All 3 strategies were associated with a notable improvement in understanding of post-intensive care syndrome, with no single strategy being superior. Nineteen bedside nurses completed a survey on how daily workflow was affected and education was perceived. The survey indicated that all 3 interventions minimally disrupted workflow and all were recognized as useful. Final analysis indicated that brochures have the greatest likelihood of successful and sustainable implementation in the study hospital. CONCLUSION Simple, low-cost education can improve caregivers' knowledge of post-intensive care syndrome and can be well supported by nursing staff. To ensure sustainable implementation, the characteristics of the unit should be considered when selecting an educational program.
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Affiliation(s)
- Stephanie A. Esses
- Stephanie A. Esses is a lead pediatric nurse practitioner in the pediatric intensive care unit, St Louis Children’s Hospital, St Louis, Missouri. Ashley Rodemann is a social worker. Sara Small is a social worker and Mary E. Hart-man is an assistant professor, Department of Pediatrics, Washington University in St Louis, St Louis, Missouri
| | - Sara Small
- Stephanie A. Esses is a lead pediatric nurse practitioner in the pediatric intensive care unit, St Louis Children’s Hospital, St Louis, Missouri. Ashley Rodemann is a social worker. Sara Small is a social worker and Mary E. Hart-man is an assistant professor, Department of Pediatrics, Washington University in St Louis, St Louis, Missouri
| | - Ashley Rodemann
- Stephanie A. Esses is a lead pediatric nurse practitioner in the pediatric intensive care unit, St Louis Children’s Hospital, St Louis, Missouri. Ashley Rodemann is a social worker. Sara Small is a social worker and Mary E. Hart-man is an assistant professor, Department of Pediatrics, Washington University in St Louis, St Louis, Missouri
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A Pilot Randomized Controlled Trial of an Intervention to Promote Psychological Well-Being in Critically Ill Children: Soothing Through Touch, Reading, and Music. Pediatr Crit Care Med 2018; 19:e358-e366. [PMID: 29659416 DOI: 10.1097/pcc.0000000000001556] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To examine the feasibility and acceptability of a PICU Soothing intervention using touch, reading, and music. DESIGN Nonblinded, pilot randomized controlled trial. SETTING The PICU and medical-surgical wards of one Canadian pediatric hospital. PATIENTS Twenty PICU patients age 2-14 years old and their parents, randomized to an intervention group (n = 10) or control group (n = 10). INTERVENTION PICU Soothing consisted of: 1) parental comforting (touch and reading), followed by 2) a quiet period with music via soft headbands, administered once daily throughout hospitalization. MEASUREMENTS AND MAIN RESULTS Acceptability and feasibility of the intervention and methods were assessed via participation rates, observation, measurement completion rates, semistructured interviews, and telephone calls. Psychological well-being was assessed using measures of distress, sleep, and child and parent anxiety in the PICU, on the wards and 3 months post discharge. Forty-four percent of parents agreed to participate. Seventy percent and 100% of intervention group parents responded positively to comforting and music, respectively. Most intervention group parents (70%) and all nurses felt children responded positively. All nurses found the intervention acceptable and feasible. Measurement completion rates ranged from 70% to 100%. Pilot data suggested lower intervention group child and parent anxiety after transfer to hospital wards. CONCLUSIONS PICU Soothing is acceptable and feasible to conduct. Results support the implementation of a full-scale randomized controlled trial to evaluate intervention effectiveness.
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Watson RS, Choong K, Colville G, Crow S, Dervan LA, Hopkins RO, Knoester H, Pollack MM, Rennick J, Curley MAQ. Life after Critical Illness in Children-Toward an Understanding of Pediatric Post-intensive Care Syndrome. J Pediatr 2018; 198:16-24. [PMID: 29728304 DOI: 10.1016/j.jpeds.2017.12.084] [Citation(s) in RCA: 135] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Revised: 12/06/2017] [Accepted: 12/28/2017] [Indexed: 12/12/2022]
Affiliation(s)
- R Scott Watson
- Center for Child Health, Behavior, and Development, Seattle Children's Research Institute, Seattle, WA; Pediatric Critical Care Medicine, Department of Pediatrics, University of Washington, Seattle, WA.
| | - Karen Choong
- Department of Pediatrics and Critical Care, McMaster University, Hamilton, Ontario, Canada
| | - Gillian Colville
- Paediatric Psychology Service, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Sheri Crow
- Department of Pediatrics and Health Services Research, Mayo Clinic, Rochester, MN
| | - Leslie A Dervan
- Pediatric Critical Care Medicine, Department of Pediatrics, University of Washington, Seattle, WA
| | - Ramona O Hopkins
- Psychology Department and Neuroscience Center, Brigham Young University, Provo, UT; Center for Humanizing Critical Care, Intermountain Health Care, Murray, UT; Department of Medicine, Pulmonary & Critical Care Division, Intermountain Medical Center, Murray, UT
| | - Hennie Knoester
- Emma Children's Hospital/Academic Medical Centre, University of Amsterdam, The Netherlands
| | - Murray M Pollack
- Children's National Health System, George Washington University, Washington, DC
| | - Janet Rennick
- Department of Nursing, Montreal Children's Hospital, Ingram School of Nursing and Department of Pediatrics (Division of Critical Care), Faculty of Medicine, McGill University, Montreal, Quebec, Canada
| | - Martha A Q Curley
- Family and Community Health, School of Nursing, Anesthesia and Critical Care Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Critical Care and Cardiovascular Program, Boston Children's Hospital, Boston, MA
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Psychological and Psychiatric Outcomes Following PICU Admission: A Systematic Review of Cohort Studies. Pediatr Crit Care Med 2018; 19:e58-e67. [PMID: 29189670 DOI: 10.1097/pcc.0000000000001390] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVE Admissions to PICU places pediatric patients at increased risk of persistent psychological and psychiatric morbidity. This systematic review aimed to summarize and critically examine literature regarding psychological and psychiatric outcomes of pediatric patients following PICU admission. DATA SOURCES MEDLINE, Web of Science, Cochrane Library, Science Direct, PsycInfo, CINAHL, LILACS, and SciELO were searched up to May 2016. STUDY SELECTION Cohort studies about psychological and psychiatric outcomes of pediatric patients following PICU admission; full-text records published in English, Spanish, or Portuguese in peer-reviewed journals from 2000 to 2015 were included. Neonatal patient population (age, <1 mo), follow-up after PICU discharge (<3 mo), and nonprimary literature were excluded. Two reviewers independently screened studies based on the predetermined exclusion criteria. DATA EXTRACTION Data were extracted using an adapted tool. The internal validity and risk of bias were assessed using Newcastle-Ottawa Scale. DATA SYNTHESIS The search yielded 1,825 studies after the removal of duplications, of which eight met the inclusion criteria. Methodologic quality of the studies ranged from low to high, with an average score of five of nine. Of all the studies, half had a control group. Regarding the length of follow-up, most of the studies ranged from 3 to 12 months. CONCLUSIONS Psychological and psychiatric outcomes after pediatric critical illness appear to be substantial issues that need to be further studied. Our review highlights the need for psychological screening of pediatric patients and their parents following PICU admission since these patients are a vulnerable population at risk for developing psychiatric responses.
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PSIQUIATRÍA DE ENLACE EN NIÑOS Y ADOLESCENTES. MANEJO DEL PACIENTE Y SU FAMILIA EN UNIDADES PEDIÁTRICAS DE ALTA COMPLEJIDAD. REVISTA MÉDICA CLÍNICA LAS CONDES 2017. [DOI: 10.1016/j.rmclc.2017.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Abstract
The focus of critical care has evolved from saving lives to preservation of function. Morbidity rates in pediatric critical care are approximately double mortality rates. Morbidity includes complications of disease and medical care. In pediatric critical care, functional status morbidity is an intermediate outcome in the progression toward death and is the result of the same factors associated with mortality, including physiologic profiles and case-mix factors. The Functional Status Scale developed by Collaborative Pediatric Critical Care Research Network is a validated, granular, age-independent measure of functional status that has proved valuable and practical even in large outcome studies.
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Systematic Review of Interventions to Reduce Psychiatric Morbidity in Parents and Children After PICU Admissions. Pediatr Crit Care Med 2017; 18:343-348. [PMID: 28207571 DOI: 10.1097/pcc.0000000000001096] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
OBJECTIVE To describe and evaluate interventions aimed at reducing psychiatric morbidity in parents and children discharged from PICU. DATA SOURCES A systematic review of the literature was undertaken, searching EMBASE, PSYCHinfo, MEDLINE, and CINAHL. Experts in the field were contacted to identify unpublished studies. STUDY SELECTION Exclusion criteria: Studies with participants above age 18 or drawn from a neonatal ICU, studies not in English, and those not measuring psychopathology. DATA EXTRACTION Seven hundred fifty-three articles initially identified were hand searched which identified three studies, with a further three studies found by contacting experts in the field. Of these, three were randomized controlled trials and three feasibility studies. DATA SYNTHESIS The interventions primarily targeted parents (particularly mothers), with the aim of reducing psychopathology especially posttraumatic stress disorder. Findings from these few studies demonstrated that interventions can lead to a reduction in parent and child psychopathology. Key ingredients of these interventions included psychoeducation, parent support after discharge, offering intervention to those families at high risk of developing psychopathology as identified by screening at the point of discharge, follow-up of all families with the aim of case finding, and specific interventions to target posttraumatic stress disorder symptoms. CONCLUSIONS Intervention studies are few but do lead to reductions in parent and child psychopathology. There is sufficient information to suggest some of these interventions could be supported and further evaluated.
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Gangopadhyay M, Smith H, Pao M, Silver G, Deepmala D, De Souza C, Garcia G, Giles L, Denton D, Jacobowski N, Pandharipande P, Fuchs C. Development of the Vanderbilt Assessment for Delirium in Infants and Children to Standardize Pediatric Delirium Assessment By Psychiatrists. PSYCHOSOMATICS 2017; 58:355-363. [PMID: 28506544 DOI: 10.1016/j.psym.2017.03.006] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2016] [Revised: 03/04/2017] [Accepted: 03/06/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND Pediatric delirium assessment is complicated by variations in baseline language and cognitive skills, impairment during illness, and absence of pediatric-specific modifiers within the Diagnostic and Statistical Manual of Mental Disorders delirium criterion. OBJECTIVE To develop a standardized approach to pediatric delirium assessment by psychiatrists. METHODS A multidisciplinary group of clinicians used Diagnostic and Statistical Manual criterion as the foundation for the Vanderbilt Assessment for Delirium in Infants and Children (VADIC). Pediatric-specific modifiers were integrated into the delirium criterion, including key developmental and assessment variations for children. The VADIC was used in clinical practice to prospectively assess critically ill infants and children. The VADIC was assessed for content validity by the American Academy of Child and Adolescent Psychiatry Delirium Special Interest Group. RESULTS The American Academy of Child and Adolescent Psychiatry-Delirium Special Interest Group determined that the VADIC demonstrated high content validity. The VADIC (1) preserved the core Diagnostic and Statistical Manual delirium criterion, (2) appropriately paired interactive assessments with key criterion based on development, and (3) addressed confounders for delirium. A cohort of 300 patients with a median age of 20 months was assessed for delirium using the VADIC. Delirium prevalence was 47%. CONCLUSION The VADIC provides a comprehensive framework to standardize pediatric delirium assessment by psychiatrists. The need for consistency in both delirium education and diagnosis is highlighted given the high prevalence of pediatric delirium.
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Affiliation(s)
- Maalobeeka Gangopadhyay
- Department of Psychiatry, Monroe Carell Children's Hospital, Vanderbilt University Medical Center, Nashville, TN; Department of Psychiatry, Morgan Stanley Children's Hospital, New York-Presbyterian, Columbia University, New York, NY.
| | - Heidi Smith
- Department of Anesthesiology, Monroe Carell Children's Hospital, Vanderbilt University Medical Center, Nashville, TN; Department of Pediatrics, Monroe Carell Children's Hospital, Vanderbilt University Medical Center, Nashville, TN
| | - Maryland Pao
- National Institutes of Health, National Institute of Mental Health, Bethesda, MD
| | - Gabrielle Silver
- Weill Cornell Medical Center, New York-Presbyterian, Cornell University, New York, NY
| | - Deepmala Deepmala
- Department of Psychiatry, Arkansas Children's Hospital, University of Arkansas for Medical Science, Little Rock, AK
| | - Claire De Souza
- Department of Psychiatry, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Georgina Garcia
- Department of Psychiatry, Boston Children's Hospital, Harvard University, Boston, MA
| | - Lisa Giles
- Department of Psychiatry, Primary Children's Hospital, University of Utah, Salt Lake City, UT
| | - Danica Denton
- Department of Psychiatry and Behavioral Sciences, Phoenix Children's Hospital, University of Arizona, Phoenix, AZ
| | - Natalie Jacobowski
- Pediatric Hospice and Palliative Medicine, Children's Hospital of Philadelphia, Philadelphia, PA
| | - Pratik Pandharipande
- Department of Anesthesiology, Monroe Carell Children's Hospital, Vanderbilt University Medical Center, Nashville, TN
| | - Catherine Fuchs
- Department of Psychiatry, Monroe Carell Children's Hospital, Vanderbilt University Medical Center, Nashville, TN
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50
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Fan C, Qi B, Chen C. Current views of the Pediatric Intensive Care Unit. Minerva Pediatr 2017; 71:539-543. [PMID: 28260348 DOI: 10.23736/s0026-4946.17.04738-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
International best practice endorses the use of standardized approaches in the management of pediatric patients in the Pediatric Intensive Care Unit (PICU). There is increasing awareness of the risk of prolonged duration of mechanical ventilation as a consequence of morphine use leading to ventilator-associated pneumonia, extended PICU and hospital length of stay and increased morbidity and mortality. Accordingly, a fundamental outcome measure of this study was to determine whether raising awareness of these issues and the introduction of analgesia and sedation guidelines led to a reduction in the amount of analgesics and sedatives administered to PICU patients, while not exposing them to pain and distress. The present review article is devoted to discussing all important aspects of PICU.
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Affiliation(s)
- Conghai Fan
- Intensive Care Unit, Xuzhou Children's Hospital, Xuzhou, China
| | - Boxiang Qi
- Intensive Care Unit, Xuzhou Children's Hospital, Xuzhou, China -
| | - Chao Chen
- Intensive Care Unit, Xuzhou Children's Hospital, Xuzhou, China
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