Department of Pediatric Intensive Care, Amsterdam Reproduction and Development research institute, Amsterdam UMC, University of Amsterdam, Emma Children's Hospital, Amsterdam, The Netherlands.
Department of Pediatrics, Follow Me Program & Emma Neuroscience Group, Amsterdam Reproduction and Development research institute, Amsterdam UMC, University of Amsterdam, Emma Children's Hospital, Amsterdam, The Netherlands.
Pediatr Res. 2023 Aug;94(2):603-610. doi: 10.1038/s41390-022-02460-7. Epub 2023 Jan 25.
Concerns exist regarding the impact of widely used clinical drugs on brain development. This study investigates long-term neurocognitive functioning in relation to frequently used drug exposure at the Pediatric Intensive Care Unit (PICU).
This study compared children aged 6-12 years with previous PICU admission (age ≤1 year) for bronchiolitis requiring mechanical ventilation (patient group, n = 65) to a demographically comparable control group (n = 76) on a broad range of neurocognitive outcomes. The patient group was selected because bronchiolitis seldom manifests neurologically and is therefore not expected to affect neurocognitive functioning in itself. The relation between exposure to sedatives, analgesics and anesthetics and neurocognitive outcomes was assessed by regression analyses.
The patient group had lower intelligence than the control group (p < 0.001, d = -0.59) and poorer performance in neurocognitive functions; i.e., speed and attention (p = 0.03, d = -0.41) and verbal memory (p < 0.001, d = -0.60). Exposure to sedatives, analgesics and anesthetics was not related to neurocognitive outcomes.
Children with PICU admission for bronchiolitis requiring mechanical ventilation are at risk of adverse neurocognitive outcomes. This study found no evidence for a role of exposure to sedatives, analgesics or anesthetics. Findings underline the importance of long-term follow-up after PICU admission, even in the absence of disease with neurological manifestation.
Animal studies have indicated that exposing the maturing brain to clinical drugs may cause neurodegeneration. Clinical studies show mixed evidence regarding the association between clinical drugs and neurocognitive outcomes. This study provides evidence for considerably lower neurocognitive functioning among children with a history of PICU admission for bronchiolitis compared to healthy peers. Bronchiolitis seldom manifests neurologically and is therefore not expected to affect neurocognitive functioning in itself. We found no evidence supporting a relation between drug exposure (i.e., sedatives, analgesics and anesthetics) and long-term neurocognitive outcomes. Findings underline the importance of structured follow-up after PICU admission.
人们对广泛使用的临床药物对大脑发育的影响表示担忧。本研究调查了与儿科重症监护病房（PICU）中常用药物暴露相关的长期神经认知功能。
本研究比较了因毛细支气管炎需要机械通气而在 PICU 住院（年龄≤1 岁）的 6-12 岁儿童（患者组，n=65）与年龄和人口统计学相匹配的对照组（n=76）在广泛的神经认知结果方面的差异。选择毛细支气管炎患者组是因为毛细支气管炎很少表现出神经系统表现，因此预计不会对神经认知功能本身产生影响。通过回归分析评估镇静剂、镇痛药和麻醉剂暴露与神经认知结果之间的关系。
与对照组相比，患者组的智力较低（p<0.001，d=-0.59），神经认知功能较差，即速度和注意力（p=0.03，d=-0.41）和言语记忆（p<0.001，d=-0.60）。镇静剂、镇痛药和麻醉剂的暴露与神经认知结果无关。
因毛细支气管炎需要机械通气而在 PICU 住院的儿童存在神经认知不良结局的风险。本研究没有发现暴露于镇静剂、镇痛药或麻醉剂与神经认知结果之间存在关联的证据。研究结果强调了即使在没有神经系统表现的疾病的情况下，在 PICU 住院后进行长期随访的重要性。
动物研究表明，使发育中的大脑暴露于临床药物可能会导致神经退行性变。临床研究表明，临床药物与神经认知结果之间的关联存在混合证据。本研究提供了证据表明，与健康同龄人相比，因毛细支气管炎而在 PICU 住院的儿童的神经认知功能明显较低。毛细支气管炎很少表现出神经系统表现，因此预计不会对神经认知功能本身产生影响。我们没有发现证据支持药物暴露（即镇静剂、镇痛药和麻醉剂）与长期神经认知结果之间的关系。研究结果强调了在 PICU 住院后进行结构化随访的重要性。
