False start: Role of Age and Diagnosis of Critically Ill Children Admitted to the Paediatric Intensive Care Unit in the First 1000 Days of Life on Long-term Neurocognitive and Psychosocial Development

The first 1000 days of life represent a critical window of rapid brain growth and heightened neuroplasticity during which the developing brain is particularly vulnerable to environmental influences. Critical illness requiring Paediatric Intensive Care Unit (PICU) admission during this period may disrupt brain development, placing children at risk of lasting neurocognitive and psychosocial impairments. This study examined neurocognitive and psychosocial outcomes four years after PICU admission in children admitted under two years of age, and evaluated associations with age at admission and diagnosis. As advances in critical care have substantially improved survival rates, identifying children at elevated risk for long-term impairments has become increasingly important. Given the heightened vulnerability of the young brain to adverse exposures, we expected lower neurocognitive performance and greater psychosocial difficulties at 4-year follow-up in children admitted to the PICU during...Show moreThe first 1000 days of life represent a critical window of rapid brain growth and heightened neuroplasticity during which the developing brain is particularly vulnerable to environmental influences. Critical illness requiring Paediatric Intensive Care Unit (PICU) admission during this period may disrupt brain development, placing children at risk of lasting neurocognitive and psychosocial impairments. This study examined neurocognitive and psychosocial outcomes four years after PICU admission in children admitted under two years of age, and evaluated associations with age at admission and diagnosis. As advances in critical care have substantially improved survival rates, identifying children at elevated risk for long-term impairments has become increasingly important. Given the heightened vulnerability of the young brain to adverse exposures, we expected lower neurocognitive performance and greater psychosocial difficulties at 4-year follow-up in children admitted to the PICU during this period compared with healthy controls. We further hypothesized that younger age at time of admission is associated with worse outcomes due to greater neural vulnerability and the cumulative effects of early-life adversity, and third, children with congenital conditions requiring surgery, particularly congenital heart disease, show the most pronounced impairments. The study included 392 critically ill children admitted to University Hospitals Leuven, Leuven, Belgium; or Erasmus Medical Centre, Sophia Children’s Hospital, Rotterdam, Netherlands, and 216 matched healthy children. Outcomes encompassed measures of general intelligence, visual motor integration, alertness, motor coordination and parent-reported executive functioning, emotional and behavioral problems. The impact of critical illness and associations with age at PICU admission and diagnostic category were analyzed through Multivariate Analyses Of Variance (MANOVA) and Multivariate Analyses Of Covariance (MANCOVA). In line with expectations, at 4-year follow-up, critically ill children scored significantly lower compared to controls on intelligence and visual-motor integration (F(4) = 24.3, p = < .001, ηp2 = .14), and alertness (F(4) = 4.93, p < .001, ηp2 = .05). Younger age at PICU admission (<28 days and 29 days to 11 months) was linked to reduced alertness compared with those admitted at 12 to 24 months (F(8) = 3.20, p <.01, ηp2 = .03), supporting the hypothesis of early neural vulnerability. Contrary to expectations, no significant differences were observed across diagnostic categories. The covariates parental education and occupation emerged as key predictors of cognitive performance. Additionally, prolonged antibiotic treatment was associated with more parent-reported emotional and behavioral problems, and PICU-inquired infections with lower intelligence and visual-motor integration scores. Children admitted to the PICU during the first 1000 days are at elevated risk for long-term neurodevelopmental impairments, particularly those admitted in the neonatal period and from lower educated families. Standardized follow-up should include early and ongoing screening, with targeted interventions for the most vulnerable subgroups, considering age at admission, socio-economic context, and medical exposures.Show less

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False start: Role of Age and Diagnosis of Critically Ill Children Admitted to the Paediatric Intensive Care Unit in the First 1000 Days of Life on Long-term Neurocognitive and Psychosocial Development