Yuliarto Saptadi, Ramadhanti Ardhanis, Khalasha Takhta, Kadafi Kurniawan Taufiq, Ariani Ariani
Department of Pediatrics, Medical Faculty Universitas Brawijaya, Saiful Anwar General Hospital Malang Indonesia.
Department of Pharmacology, Medical Faculty Universitas Brawijaya Malang Indonesia.
Health Sci Rep. 2023 Jun 15;6(6):e1340. doi: 10.1002/hsr2.1340. eCollection 2023 Jun.
Children admitted in the pediatric intensive care unit (PICU) often deal with long-term morbidities affecting physical, cognitive, emotional, social, and psychiatric symptoms. We aimed to identify the internal and external factors which predict the occurrence of neurocognitive and psychological disorders in survivors at 3 months after PICU discharge.
We identified 53 critically ill children, ages 4-18 years old, admitted in PICU for more than 24 h, and survived. We evaluated neurocognitive disorder with Pediatric Cerebral Perfomance Category (PCPC) and psychological disorders with Strengths and Difficulties Questionnaire (SDQ) at the time of PICU discharge and repeated in 3 months afterward. We evaluated the internal and external risk factors related to neurocognitive and psychological disorders in PICU survivors. The internal risk factors were age, gender, family composition, and socioeconomic status. The external risk factors were: surgical intervention, neurological disease, predicted death rate by pediatric index mortality (PIM)-2 score, PICU length of stay (LOS), days of mechanical ventilation, and the number of therapeutic interventions.
There were significant improvement in neurocognitive disorders (p < 0.001), peer problems, ( = 0.01), and prosocial behaviors ( = 0.00) in children at 3 months after the PICU discharge. Age of 4-5 years has a significant effect on neurocognitive disorders ( = 0.04), while male gender ( = 0.02), low-social economy, non-intact family composition ( = 0.01), neurological disease ( = 0.04), surgical intervention ( = 0.01), and TISS score ( = 0.00) have a significant effect on psychological disorders in children at 3 months after the PICU discharge.
Neurocognitive disorders, peer problems, and prosocial behaviors improved in a few patients 3 months after PICU discharge. Age of 4-5 years was a risk factor of the persisted neurocognitive disorder, whereas male gender, low-social economy, non-intact family composition, neurological disease, surgical intervention, and TISS score were risk factors of persisted psychological disorder at 3 months after PICU.
入住儿科重症监护病房（PICU）的儿童常常面临影响身体、认知、情感、社交和精神症状的长期疾病。我们旨在确定预测PICU出院3个月后幸存者发生神经认知和心理障碍的内部和外部因素。
我们确定了53名4至18岁的危重症儿童，他们入住PICU超过24小时且存活。在PICU出院时，我们用儿科脑功能分类（PCPC）评估神经认知障碍，用优势与困难问卷（SDQ）评估心理障碍，并在3个月后重复评估。我们评估了PICU幸存者中与神经认知和心理障碍相关的内部和外部风险因素。内部风险因素包括年龄、性别、家庭构成和社会经济地位。外部风险因素包括：手术干预、神经系统疾病、儿科指数死亡率（PIM）-2评分预测的死亡率、PICU住院时间（LOS）、机械通气天数以及治疗干预次数。
PICU出院3个月后，儿童的神经认知障碍（p<0.001）、同伴问题（=0.01）和亲社会行为（=0.00）有显著改善。4至5岁的年龄对神经认知障碍有显著影响（=0.04），而男性（=0.02）、低社会经济地位、不完整的家庭构成（=0.01）、神经系统疾病（=0.04）、手术干预（=0.01）和TISS评分（=0.00）对PICU出院3个月后儿童的心理障碍有显著影响。
PICU出院3个月后，部分患者的神经认知障碍、同伴问题和亲社会行为有所改善。4至5岁是持续性神经认知障碍的危险因素，而男性、低社会经济地位、不完整的家庭构成、神经系统疾病、手术干预和TISS评分是PICU出院3个月后持续性心理障碍的危险因素。
