title: Neuropsychologic function three to six months following admission to the PICU with meningoencephalitis, sepsis, and other disorders: a prospective study of school-aged children.
abstract: OBJECTIVE
  To assess short-term neuropsychological function and academic performance in school children following admission to intensive care and to explore the role of critical neurologic and systemic infection.
  
  
  METHODS
  A prospective observational case-control study.
  
  
  METHODS
  Two PICUs.
  
  
  METHODS
  A consecutive sample of 88 children aged 5-16 years (median age=10.00, interquartile range=6.00-13.00) who were admitted to intensive care between 2007 and 2010 with meningoencephalitis, septic illness, or other critical illnesses. They were assessed 3 to 6 months following discharge, and their performance was compared with that of 100 healthy controls. Patients were without prior neurologic or neurodevelopmental disorder.
  
  
  METHODS
  None.
  
  
  RESULTS
  Data encompassing demographic and critical illness details were obtained, and children were assessed using tests of intellectual function, memory, and attention. Questionnaires addressing academic performance were returned by teachers. After adjusting for covariates, the children admitted to PICUs significantly underperformed on neuropsychological measures in comparison to healthy controls (p<0.02). Teachers deemed more children admitted to PICUs than controls as performing educationally worse and having problems with school work (ps=0.001), as well as performing below average on aspects of executive function and attention (ps<0.04). Analysis of the effect of illness type on outcome revealed that aspects of neuropsychological function, such as memory function, and teacher-rated academic performance were most reduced in children with meningoencephalitis and septic illness. In the PICU group, multivariable linear regression revealed that worse performance on a composite score of neuropsychologic impairment was more prevalent when children were younger, from a lower social class, and had experienced seizures during their admission (ps<0.02).
  
  
  CONCLUSIONS
  Admission to intensive care is followed by deficits in neuropsychologic performance and educational difficulties, with more severe difficulties noted following meningoencephalitis and septic illness. These results highlight the importance of future studies on cognition and educational outcome incorporating type of illness as a moderating factor.
authors: Academic Unit of Child and Adolescent Psychiatry, Imperial College London, and Department of Paediatric Intensive Care, St. Mary's Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom. l.als@imperial.ac.uk
authors: Lorraine C
authors: LC
authors: Als
authors: Simon
authors: S
authors: Nadel
authors: Mehrengise
authors: M
authors: Cooper
authors: Christine M
authors: CM
authors: Pierce
authors: Barbara J
authors: BJ
authors: Sahakian
authors: M Elena
authors: ME
authors: Garralda
mesh_terms: D000293:Adolescent; D041923:Adolescent Development; D016022:Case-Control Studies; D015984:Causality; D002648:Child; D002657:Child Development; D002675:Child, Preschool; D003072:Cognition Disorders / Q000453:epidemiology*; D015897:Comorbidity; D016638:Critical Illness / Q000453:epidemiology*; D004522:Educational Status; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015278:Intensive Care Units, Pediatric; D007859:Learning Disabilities / Q000453:epidemiology*; D008297:Male; D008590:Meningoencephalitis / Q000453:epidemiology*; D009460:Neurologic Examination; D009483:Neuropsychological Tests; D011446:Prospective Studies; D018805:Sepsis / Q000453:epidemiology*; D012917:Social Adjustment; D006113:United Kingdom