Abstract Objective To study the risk factors for postoperative delirium (POD) in children with congenital heart disease. Methods A prospective nested case-control study was performed on children with congenital heart disease who underwent surgery in Fuwai Hospital, Chinese Academy of Medical Sciences, from December 2020 to June 2021. The clinical data were compared between the POD group (n=114) and non-POD group (n=102). A multivariate unconditional logistic regression analysis was used to investigate the risk factors for POD in children with congenital heart disease. Results The multivariate logistic regression analysis showed that age (OR=0.951, P<0.001), gender (OR=2.127, P=0.049), number of invasive catheters per day (OR=1.490, P=0.017), degree of postoperative pain (OR=5.856, P<0.001), and preoperative parental anxiety level (OR=1.025, P=0.010) were independent risk factors for POD in children with congenital heart disease. Conclusions The risk of POD increases in children with congenital heart disease who are younger, male, have higher number of invasive catheters per day, higher degree of postoperative pain, or higher preoperative parental anxiety level.
LYU Juan,JIA Yan,YAN Meng et al. Risk factors for postoperative delirium in children with congenital heart disease: a prospective nested case-control study[J]. CJCP, 2022, 24(3): 232-239.
LYU Juan,JIA Yan,YAN Meng et al. Risk factors for postoperative delirium in children with congenital heart disease: a prospective nested case-control study[J]. CJCP, 2022, 24(3): 232-239.
Ma XJ, Huang GY. Current status of screening, diagnosis, and treatment of neonatal congenital heart disease in China[J]. World J Pediatr, 2018,14(4):313-314. PMID: 30066048. DOI: 10.1007/s12519-018-0174-2.
Alvarez RV, Palmer C, Czaja AS, et al. Delirium is a common and early finding in patients in the pediatric cardiac intensive care unit[J]. J Pediatr, 2018, 195: 206-212. PMID: 29395177. DOI: 10.1016/j.jpeds.2017.11.064.
Leroy PL, Schieveld JNM. Mind the heart: delirium in children following cardiac surgery for congenital heart disease[J]. Pediatr Crit Care Med, 2017, 18(2): 196-198. PMID: 28157798. DOI: 10.1097/PCC.0000000000001038.
Krechel SW, Bildner J. CRIES: a new neonatal postoperative pain measurement score. Initial testing of validity and reliability[J]. Paediatr Anaesth, 1995, 5(1): 53-61. PMID: 8521311. DOI: 10.1111/j.1460-9592.1995.tb00242.x.
Merkel SI, Voepel-Lewis T, Shayevitz JR, et al. The FLACC: a behavioral scale for scoring postoperative pain in young children[J]. Pediatr Nurs, 1997, 23(3): 293-297. PMID: 9220806.
Slater A, Shann F, ANZICS Paediatric Study Group. The suitability of the pediatric index of mortality (PIM), PIM2, the pediatric risk of mortality (PRISM), and PRISM III for monitoring the quality of pediatric intensive care in Australia and New Zealand[J]. Pediatr Crit Care Med, 2004, 5(5): 447-454. PMID: 15329160. DOI: 10.1097/01.PCC.0000138557.31831.65.
Jenkins KJ, Gauvreau K, Newburger JW, et al. Consensus-based method for risk adjustment for surgery for congenital heart disease[J]. J Thorac Cardiovasc Surg, 2002, 123(1): 110-118. PMID: 11782764. DOI: 10.1067/mtc.2002.119064.
17 World Health Organization. Stunting, wasting, overweight and underweight[EB/OL]. [2021-08-21]. https://apps.who.int/nutrition/landscape/help.aspx?menu=0&helpid=391&lang=EN.
Aldecoa C, Bettelli G, Bilotta F, et al. European Society of Anaesthesiology evidence-based and consensus-based guideline on postoperative delirium[J]. Eur J Anaesthesiol, 2017, 34(4): 192-214. PMID: 28187050. DOI: 10.1097/EJA.0000000000000594.
Harris J, Ramelet AS, van Dijk M, et al. Clinical recommendations for pain, sedation, withdrawal and delirium assessment in critically ill infants and children: an ESPNIC position statement for healthcare professionals[J]. Intensive Care Med, 2016, 42(6): 972-986. PMID: 27084344. PMCID: PMC4846705. DOI: 10.1007/s00134-016-4344-1.
Meyburg J, Dill ML, von Haken R, et al. Risk factors for the development of postoperative delirium in pediatric intensive care patients[J]. Pediatr Crit Care Med, 2018, 19(10): e514-e521. PMID: 30059477. DOI: 10.1097/PCC.0000000000001681.
Kain ZN, Caldwell-Andrews AA, Maranets I, et al. Preoperative anxiety and emergence delirium and postoperative maladaptive behaviors[J]. Anesth Analg, 2004, 99(6): 1648-1654. PMID: 15562048.DOI: 10.1213/01.ANE.0000136471.36680.97.
Bryant KJ. Pediatric delirium in the cardiac intensive care unit: identification and intervention[J]. Crit Care Nurse, 2018, 38(4): e1-e7. PMID: 30068726. DOI: 10.4037/ccn2018947.
Fan H, Ji M, Huang J, et al. Development and validation of a dynamic delirium prediction rule in patients admitted to the Intensive Care Units (DYNAMIC-ICU): a prospective cohort study[J]. Int J Nurs Stud, 2019,93:64-73. PMID: 30861455. DOI:10.1016/j.ijnurstu.2018.10.008.
Ong C, Han WM, Wong JJM, et al. Nutrition biomarkers and clinical outcomes in critically ill children: a critical appraisal of the literature[J]. Clin Nutr, 2014, 33(2): 191-197. PMID: 24423748. DOI: 10.1016/j.clnu.2013.12.010.
[1]
Shaanxi Provincial Diagnosis and Treatment Center of Kawasaki Disease/Children's
Hospital of Shaanxi Provincial People's Hospital; Beijing Children's Hospital, Capital Medical University; Shanghai
Children's Medical Center; Children's Hospital of Shanghai Jiao Tong University; Xianyang Children's Hospital of
Shaanxi Province; Suzhou Children's Hospital, Suzhou University; Children's Hospital of Chongqing Medical University;
Expert Committee of Advanced Training for Pediatrician, China Maternal and Children's Health Association; Editorial Board of
Chinese Journal of Contemporary Pediatrics. Pediatric expert consensus on the application of glucocorticoids in Kawasaki disease[J]. CJCP, 2022, 24(3): 225-231.
