Abstract
Bronchiolitis is a common pediatric intensive care unit (PICU) illness and often affects
generally healthy children, making it a promising disease in which to study long-term
neurodevelopmental outcomes. We previously found that approximately 15% of critical
bronchiolitis patients have evidence of post-PICU morbidity using coarse definitions
available in administrative data sets. In this study, we measured neurodevelopmental
outcomes using four more precise tools. Children who had previously been admitted
to our PICU with bronchiolitis were included; those with evidence of developmental
delay at PICU admission were excluded. Approximately 1 to 2 years after PICU discharge,
the parent of each subject completed two questionnaires (Ages and Stages Questionnaire
and Pediatric Evaluation of Disability Inventory Computer Adaptive Test). Each subject
also underwent two in-person assessments administered by a certified examiner (Bayley
Scales of Infant and Toddler Development, 3rd edition, and the Amiel-Tison neurological
assessment). For each domain of each test, a score of > 1 standard deviation below
the norm for the subject's age defined “moderate” disability and a score ≥ 2 standard
deviations below the norm defined “severe” disability. Eighteen subjects (median ages
of 3.7 months at PICU admission and 2.3 years at testing) were enrolled, 17 of whom
were supported by high-flow nasal cannula and/or mechanical ventilation. Fifteen children
(83%) scored abnormally on ≥ 1test. Eight children (44%) had disabilities in ≥ 3 domains
and/or ≥ 1 severe disability identified. Our findings that motor, language, and cognitive
disabilities are commonly observed months to years after critical bronchiolitis require
larger studies to confirm this finding, assess causality, and identify modifiable
risk factors.
Keywords
pediatrics - critical care - post-intensive care syndrome
