Effects of critical illness on the functional status of children with a history of prematurity

Peduce, Millene Albeche; Dannenberg, Vanessa Campes; Rovedder, Paula Maria Eidt; Carvalho, Paulo Roberto Antonacci

doi:10.5935/0103-507X.20220429-en

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Revista Brasileira de Terapia Intensiva

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ORIGINAL ARTICLE • Rev. bras. ter. intensiva 34 (4) • Oct-Dec 2022 • https://doi.org/10.5935/0103-507X.20220429-en copy

Effects of critical illness on the functional status of children with a history of prematurity

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

To evaluate the effects of critical illness on the functional status of children aged zero to 4 years with or without a history of prematurity after discharge from the pediatric intensive care unit.

Methods:

This was a secondary cross-sectional study nested in an observational cohort of survivors from a pediatric intensive care unit. Functional assessment was performed using the Functional Status Scale within 48 hours after discharge from the pediatric intensive care unit.

Results:

A total of 126 patients participated in the study, 75 of whom were premature, and 51 of whom were born at term. Comparing the baseline and functional status at pediatric intensive care unit discharge, both groups showed significant differences (p < 0.001). Preterm patients exhibited greater functional decline at discharge from the pediatric intensive care unit (61%). Among patients born at term, there was a significant correlation between the Pediatric Index of Mortality, duration of sedation, duration of mechanical ventilation and length of hospital stay with the functional outcomes (p = 0.05).

Conclusion:

Most patients showed a functional decline at discharge from the pediatric intensive care unit. Although preterm patients had a greater functional decline at discharge, sedation and mechanical ventilation duration influenced functional status among patients born at term.

Keywords:
Premature; Morbidity; Child; hospitalized; Intensive care units; pediatric; Functional status

	Total (n = 126)	Premature (n = 75)	Full-term (n = 51)	p value
Previous characteristics
Male sex	83 (66)	50 (67)	33 (65)	0.97^* * Yates continuity correction; † Mann-Whitney U test; ‡ Pearson’s chi-square test; § Fisher’s exact test; ¶ Corrected age calculation performed for patients born preterm who had a chronological age ≤ 24 months at the time of admission. Values are described as n (%) and median and interquartile range (25 -75).
Corrected age (months)¶	5 (2 - 15)	8 (2 - 21)	4 (1 - 7)	0.004†
Birth weight (g)
1.000 - 1.500	20 (16)	20 (27)	0
1.501 - 2.500	40 (32)	36 (48)	4 (8)	< 0.001‡
< 2.500	66 (52)	19 (25)	47 (92)
Complications in childbirth	58 (46)	42 (57)	16 (31)	0.07^* * Yates continuity correction; † Mann-Whitney U test; ‡ Pearson’s chi-square test; § Fisher’s exact test; ¶ Corrected age calculation performed for patients born preterm who had a chronological age ≤ 24 months at the time of admission. Values are described as n (%) and median and interquartile range (25 -75).
Use of continuous medication	51 (40)	50 (67)	1 (2)	< 0.001^* * Yates continuity correction; † Mann-Whitney U test; ‡ Pearson’s chi-square test; § Fisher’s exact test; ¶ Corrected age calculation performed for patients born preterm who had a chronological age ≤ 24 months at the time of admission. Values are described as n (%) and median and interquartile range (25 -75).
Technology at admission	44 (35)	44 (59)	0	< 0.001^* * Yates continuity correction; † Mann-Whitney U test; ‡ Pearson’s chi-square test; § Fisher’s exact test; ¶ Corrected age calculation performed for patients born preterm who had a chronological age ≤ 24 months at the time of admission. Values are described as n (%) and median and interquartile range (25 -75).
None	82 (65)	31 (41)	0
Food	12 (9.5)	12 (16)	0	< 0.001§
Respiratory	2 (1.6)	2 (3)	0
More than one technology	30 (24)	30 (40)	0
Previous hospitalization	100 (79)	71 (95)	29 (57)	< 0.001^* * Yates continuity correction; † Mann-Whitney U test; ‡ Pearson’s chi-square test; § Fisher’s exact test; ¶ Corrected age calculation performed for patients born preterm who had a chronological age ≤ 24 months at the time of admission. Values are described as n (%) and median and interquartile range (25 -75).
Main caregiver
Mother	103 (82)	58 (78)	45 (88)
Father	9 (7)	4 (5)	5 (10)	0.08§
Grandmother	11 (9)	11 (15)	0
Other	2 (1,6)	1 (1)	1 (2)
Caregiver educational level
Incomplete elementary school	35 (28)	20 (27)	15 (30)
Complete elementary school/Incomplete secondary school	39 (31)	23 (32)	16 (32)	0.97§
Complete high school/Incomplete higher education	42 (33)	26 (36)	16 (32)
Complete higher education	7 (6)	4 (6)	3 (6)
Clinical factors
PIM2	0.99 (0.27 - 4.24)	1.37 (0.4 - 9.6)	0.65 (0.16 - 2)	0.02†
Reason for admission
Neurologic	7 (5)	6 (8)	1 (2)	0.03§
Respiratory	73 (58)	36 (48)	37 (72)
Surgical procedure	32 (25)	24 (32)	8 (16)
Other	6 (5)	9 (12)	5 (9)
Use of sedatives	95 (75)	60 (80)	35 (69)	0.21^* * Yates continuity correction; † Mann-Whitney U test; ‡ Pearson’s chi-square test; § Fisher’s exact test; ¶ Corrected age calculation performed for patients born preterm who had a chronological age ≤ 24 months at the time of admission. Values are described as n (%) and median and interquartile range (25 -75).
Sedation time (days)	2 (0 - 6)	2 (1 - 6)	1 (0 - 5)	0.20†
Neuromuscular blocker	27 (21)	17 (23)	10 (20)	0.85^* * Yates continuity correction; † Mann-Whitney U test; ‡ Pearson’s chi-square test; § Fisher’s exact test; ¶ Corrected age calculation performed for patients born preterm who had a chronological age ≤ 24 months at the time of admission. Values are described as n (%) and median and interquartile range (25 -75).
Adverse event/complication	46 (36)	32 (43)	14 (28)	0.12^* * Yates continuity correction; † Mann-Whitney U test; ‡ Pearson’s chi-square test; § Fisher’s exact test; ¶ Corrected age calculation performed for patients born preterm who had a chronological age ≤ 24 months at the time of admission. Values are described as n (%) and median and interquartile range (25 -75).
Use of IMV	61 (48)	38 (51)	23 (45)	0,66^* * Yates continuity correction; † Mann-Whitney U test; ‡ Pearson’s chi-square test; § Fisher’s exact test; ¶ Corrected age calculation performed for patients born preterm who had a chronological age ≤ 24 months at the time of admission. Values are described as n (%) and median and interquartile range (25 -75).
Time of IMV (days)	0 (0 - 6)	1 (0 - 6)	0 (0 - 6)	0,49†
Length of hospital stay	7 (4 - 10)	7 (4 - 10)	6 (4 - 10)	0.14†
Functional decline at discharge	91 (72)	61 (81)	30 (59)	0.01^* * Yates continuity correction; † Mann-Whitney U test; ‡ Pearson’s chi-square test; § Fisher’s exact test; ¶ Corrected age calculation performed for patients born preterm who had a chronological age ≤ 24 months at the time of admission. Values are described as n (%) and median and interquartile range (25 -75).
Use of technology at discharge	105 (84)	65 (87)	40 (78)	0.23^* * Yates continuity correction; † Mann-Whitney U test; ‡ Pearson’s chi-square test; § Fisher’s exact test; ¶ Corrected age calculation performed for patients born preterm who had a chronological age ≤ 24 months at the time of admission. Values are described as n (%) and median and interquartile range (25 -75).
Type of technology
None	20 (16)	9 (12)	11 (22)	0.01‡
Food	14 (11)	9 (12)	5 (9)
Respiratory	19 (15)	6 (8)	13 (25)
More than one technology	73 (58)	51 (68)	22 (43)

	Preterm (n = 75)	Full term (n = 51)	p value^* * Pearson’s chi-square test. Values are described as n (%).
Baseline functional status (admission)
Normal	33 (45)	49 (96)	<0.001
Mildly abnormal	32 (43)	1 (2)
Moderately abnormal	9 (12)	1 (2)
Severely/Very severely abnormal	0	0
Functional status at discharge from the pediatric ICU
Normal	8 (11)	20 (39)	< 0.001
Mildly abnormal	12 (16)	24 (47)
Moderately abnormal	42 (56)	5 (11)
Severely/Very severely abnormal	13 (17)	2 (4)

Variables	FSS functional outcome
	Premature		Full-term
	ρ	ρ	ρ	ρ
Age (months)^* * Corrected age calculation performed up to 2 years of age for preterm patients. Statistical significance = p < 0.05.	0.23	0.04	-0.14	0.30
PIM2	-0.11	0.34	0.31	0.02
Sedation time (days)	0.12	0.27	0.48	< 0.001
Time of IMV (days)	0.10	0.38	0.54	< 0.001
Length of hospital stay	0.13	0.26	0.37	0.006

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[1] Conflicts of interest: None.