The Prevalence of Neurocognitive Decline in Children Following Sepsis Admission

Monday, February 24, 2025

11:05am – 12:05pm Eastern Time

Location: Connections Central Theater 1

Alicia M. Alcamo, MD, MPH

Children's Hospital of Philadelphia

Disclosure(s): No relevant financial relationship(s) to disclose.
SD

Shawn Dickey, MHA

Research Assistant
The Children's Hopsital of Philadelphia

Disclosure information not submitted.
NT

Nina Thomas, PhD, ABPP-Cn

Associate Professor of Clinical Psychiatry
The Children's Hospital of Philadelphia

Disclosure information not submitted.
BS

Beth Slomine, PhD, ABPP

Assistant Vice President of Psychology, Professor of Psychiatry and Behavioral Sciences
Kennedy Krieger Institute, Johns Hopkins University

Disclosure information not submitted.
MC

Martha A.Q. Curley, PhD, RN

Professor & Ruth M. Colket Endowed Chair in Pediatric Nursing
University of Pennsylvania School of Nursing

Disclosure information not submitted.
Scott L. Weiss, MD, FCCM

Nemours Childrens Hospital
Sidney Kimmel Medical Center at Thomas Jefferson University

Disclosure information not submitted.
JF

Julie C. Fitzgerald, MD, PhD, MSCE

Division of Critical Care Medicine, Department of Anesthesia and Critical Care
Children’s Hospital of Philadelphia and the Perelman School of Medicine, University of Pennsylvania

Disclosure information not submitted.
AT

Alexis Topjian, MD, MSCE, FCCM

Director, Neurocritical Care; Professor of Anesthesiology, Critical Care, and Pediatrics
Childrens Hospital of Philadelphia

Disclosure information not submitted.

Disclosure(s):

Alicia M. Alcamo, MD, MPH: No relevant financial relationship(s) to disclose.

Introduction: Neurocognitive decline occurs in 20-50% of adult sepsis survivors. Limited data exist about the impact of sepsis on neurocognitive decline in children. We aim to describe the prevalence of neurocognitive decline in pediatric sepsis survivors 3 months after discharge.

Methods: We conducted a prospective cohort study of children admitted to the intensive care unit from Jan 2022-Apr 2024 with sepsis defined by the International Pediatric Sepsis Consensus Criteria. Exclusion criteria included: 1) age < 2 or >17, 2) severe baseline disability (admission POPC score ≥4), 3) non-English or Spanish speaking, and 4) not expected to survive hospitalization. Parents completed questionnaires at enrollment (reflects pre-hospital baseline) and 3 months after discharge. The primary outcome was decline from baseline at 3 months on the PedsQL Cognitive Functioning Scale of at least 5.9 points (validated minimal clinically important difference). The secondary outcome was decline determined by an increased score between baseline and 3 months on the Behavior Rating Inventory of Executive Functioning (BRIEF) of at least 5 T-score points. The questionnaires assess different neurocognitive domains. PedsQL measures the impact of cognitive function on quality of life and BRIEF measures executive function. Loss-to-follow-up was defined as not completing either questionnaire at 3 months. Categorical data were compared using the chi-squared test and continuous data compared using Wilcoxon rank-sum test.

Results: 52 sepsis survivors were enrolled with 38 (73%) completing 3-month follow-up. Neurocognitive decline occurred in 29% measured by PedsQL (11/38) and 15% measured by BRIEF (3/20). For children with both questionnaires completed, BRIEF identified additional children with neurocognitive decline that were not also identified by PedsQL. In total, 37% (14/38) of children had neurocognitive decline measured by either questionnaire. There were no differences in demographics or illness severity between those with versus without neurocognitive decline.

Conclusions: One in three pediatric sepsis survivors exhibit neurocognitive decline at 3 months after discharge. Lower completion of the BRIEF may underestimate the rate of neurocognitive decline. Further studies are needed to identify risk factors for neurocognitive decline.