Prevalence and Predictive Risk Factors of Pediatric Delirium after Cardiac Surgery

Background: Postoperative delirium is associated with various risk factors in adults that also occur in the perioperative course of children undergoing cardiac surgery. Compared with older screening methods, the newly developed Cornell Assessment of Pediatric Delirium (CAPD) score now offers the possibility to screen infants and toddlers for delirium. With the increasing focus on neurodevelopment and the existing knowledge of the neuropsychological impact of delirium in adults, there is an urgent need to determine the prevalence of pediatric delirium after cardiac surgery, identify perioperative risk factors to implement prevention and treatment options, and improve neurodevelopmental outcomes

Methods: The primary endpoint of this retrospective, single-center study was to determine the prevalence of pediatric delirium using CAPD and differentiate it from pediatric withdrawal syndrome (iatrogenic withdrawal syndrome [IWS]) using the withdrawal assessment tools 1 (WAT-1). The screening was performed every 8 hours postoperatively in all patients undergoing cardiac surgery. As a secondary, exploratory endpoint, we performed a multivariate regression analysis including the following independent variables: patient age, severity of cardiac surgery (RACHS-1), bypass time (CPBT), hypoxia (SaO₂ <92% for more than 6 hours), severity of IWS (mild: WAT-1: 3–7, severe: WAT-1 >7), metabolic derailment (blood glucose >250 mg/dL), low cardiac output (LCO; lactate >2 mmol/L), ventilation time, inflammatory response syndrome (SIRS) and postoperative infections.

Results: Screening was performed in over 95% (n = 293) of all children after cardiac surgery (n = 311). The prevalence for pediatric delirium (CAPD >9) was 38.5% and 43.7% for IWS. Mild IWS (odds ratio [OR] 7.4, p ≤ 0.001), severe IWS (OR 16.03, p ≤ 0.001), and long-term ventilation (>100 hours, OR 5.4 [p = 0.008]) were significant predictors for the development of delirium. Infants (1–12 months) seem to be most frequently affected (OR 2.3, p = 0.11) and there seems to be an association with postoperative LCO (OR 2.1, p = 0.14), while RACHS-1 (OR 1.0, p = 0.89) and CPBT (OR 0.95, p = 0.57) are not significant predictors.

Conclusion: Pediatric delirium and IWS have a very high prevalence in children after cardiac surgery, so screening tools should be a standard in postoperative care. Since IWS is a significant risk factor, sedation and weaning strategies should be improved. As the risk of delirium increases with ventilation time consistent implementation and further development of fast-track concepts should be a priority.

Publication History

Article published online:
11 February 2025