Acute respiratory failure in early childhood may affect long-term neurocognitive outcomes

In a new study, survival of ICU hospitalization for acute respiratory failure and discharge without severe cognitive dysfunction in early childhood was associated with significantly lower subsequent IQ scores compared with matched siblings.

“Outcomes of adults with respiratory failure are affected by adult-onset comorbidities and age-related frailty and diminished cognitive capacity,” R. Scott Watson, MD, MPH, professor in the department of pediatrics at the University of Washington and the Center for Child Health, Behavior and Development at Seattle Children’s Research Institute, and colleagues wrote in JAMA. “In contrast, little data exist regarding long-term neurocognitive outcomes after respiratory failure in infants and children without prenatal problems or identified cognitive dysfunction.”

The researchers conducted a prospective cohort study that enrolled 121 sibling pairs from September 2014 to December 2017 from 31 U.S. pediatric ICUs (PICU) and associated neuropsychology testing centers. All pairs underwent neurocognitive testing beginning March 2015 with final follow-up in November 2018.

Patients with acute respiratory failure were aged 8 years or younger with a Pediatric Cerebral Performance Category score of 1, indicating normal neurocognitive function, before PICU admission and a score of 3 or less after discharge, indicating no worse than moderate neurocognitive dysfunction. The study excluded children with a history of neurocognitive deficits and those who required readmission and mechanical ventilation. Siblings were aged 4 to 16 years with a Pediatric Cerebral Performance Category score of 1 without a history of mechanical ventilation or general anesthesia.

The primary outcome was IQ score, which was estimated by age-appropriate Vocabulary and Block Design subtests of the Wechsler Intelligence Scale. Secondary outcomes were measures of attention, processing speed, learning, memory, visuospatial and motor skills, language and executive function.

Patients with acute respiratory failure underwent PICU care at a median age of 1 year (45% female). These children received a median of 5.5 days of invasive mechanical ventilation.

The children with acute respiratory failure were tested at a median age of 6.6 years and matched siblings were tested at a median age of 8.4 years.

Compared with matched siblings, children with acute respiratory failure had a lower mean estimated IQ score (104.3 vs. 101.5).

“The magnitude of the difference was small and of uncertain clinical importance,” the researchers wrote.

Children with acute respiratory failure also had significantly lower scores on nonverbal memory (mean difference, –0.9), visuospatial skills (mean difference, –0.9) and fine motor control (mean difference, –3.1) with significantly higher scores for processing speed (mean difference, 4.4) compared with matched siblings.

Researchers observed no significant differences in the remaining secondary outcomes.

“The much greater rates of patients with estimated IQs less than or equal to 85 and of estimated IQ at least 15 points below their siblings demonstrates an overall downward shift in estimated IQ among patients,” the researchers wrote. “These findings may have important academic, social and economic implications for young children surviving acute respiratory failure and are consistent with a 2020 study that found school problems among 13% of all pediatric ICU survivors in Finland.”