Follow-up after Pediatric Intensive Care Unit Admission From mortality to morbidity

Although the survival rate of children admitted to the Pediatric Intensive Care Unit (PICU) has substantially increased during the past decades, long-term morbidity after PICU admission is a growing concern.
Meta-analytic techniques were used to quantify intelligence outcome after PICU admission and to explore risk factors for poor intelligence outcome, based on a review of the existing literature. All studied PICU subgroups had lower intelligence compared to controls (range 0.38-0.88 SD). Later year of PICU admission, longer length of PICU stay, female sex and lower survival rates in the studied groups, were related to greater intelligence impairment.
The studies in this thesis that focused on children with a history of invasive mechanical ventilation for bronchiolitis indicate that these children are at risk of adverse long-term neurocognitive functioning, academic performance and health-related quality of life regarding school functioning at 6-12 years of age. The observed adverse intelligence outcome was found to contribute to the observed academic underachievement regarding reading comprehension and arithmetic performance. Contrary to our hypothesis, we found no evidence for a relationship between exposure to sedatives, analgesics, anesthetics or a combination of these drugs and neurocognitive outcomes.
The results of this thesis also show that one-quarter of children with a history of invasive mechanical ventilation for bronchiolitis had adverse long-term pulmonary outcomes at 6-12 years of age. The most frequent diagnosis in these children with morbidity was asthma. In the majority of the children, these adverse pulmonary outcomes had gone previously undetected. The presence of atopic disease in family and/or longer duration of invasive mechanical ventilation were associated with the presence of asthma at follow-up.
At last, this thesis describes the process of successful development and implementation of a structured multidisciplinary follow-up program for patients and their parents after PICU admission in the Emma Children’s Hospital, Amsterdam UMC, the Netherlands.