Meghan Gray, NewYork-Presbyterian Morgan Stanley Children's Hospital, New York, NY, United States; Chani Traube, Weill Cornell Medical College, New York, NY, United States; Andrew S. Geneslaw, Columbia University Irving Medical Center, New York, NY, United States
Pediatric Resident NewYork-Presbyterian Morgan Stanley Children's Hospital New York, New York, United States
Background: Delirium is an under-recognized problem in critically ill children. Although delirium is common in adults hospitalized with COVID-19, the relationship between pediatric COVID-19 and delirium has not been studied.
Objective: To characterize delirium in critically ill children with different manifestations of COVID-19, and investigate associations among demographic, disease, and treatment factors.
Design/Methods: We performed a single-center, observational cohort study of children less than 18 years of age hospitalized in the PICU between March 2020 and May 2021 with either active SARS-CoV-2 infection or serological evidence of prior infection. The primary outcome was diagnosis with delirium as defined by a positive Cornell Assessment of Pediatric Delirium screen. Hospitalizations were categorized as COVID-19 respiratory illness, multisystem inflammatory disorder in children (MIS-C), or not primarily due to COVID-19.
Results: Ninety-eight patients met inclusion criteria and accounted for 119 PICU admissions. Twenty-eight (24.5%) were due to COVID-19 respiratory illness, 32 (27%) MIS-C, and 59 (49.5%) not primarily due to COVID-19. Twenty-nine percent of children required invasive mechanical ventilation (IMV) for a median duration of 5 days (IQR 2-24). During these hospitalizations 34 (29%) children were diagnosed with delirium, which persisted for a median of 4 days (IQR 2-9). Delirium was most common in children with respiratory COVID-19 (43%), compared to 12% with MIS-C and 31% with other diagnoses (p=0.031). Delirium was more common in children with developmental delay (41% vs 15%, p< 0.01) and chronic conditions (71% vs 36%, p< 0.01) than those without. Requiring IMV was associated with delirium (71% vs 12%, p< 0.001), but risk of mortality as defined by the Pediatric Index of Mortality, 3rd Edition was not (4% vs 3.6%, p=0.5).Delirium was associated with exposure to benzodiazepines (68% vs 28%), opiates (71% vs 27%), dexmedetomidine (71% vs 14%), and paralytics (59% vs 3.5%) (p < 0.001 for each), but not with exposure to steroids, anticholinergics, or vasoactive medications. Conclusion(s): Delirium is common among children hospitalized with COVID-19, but less so among children with MIS-C. Risk factors were overall similar to those previously described in critically ill children, and were primarily related to underlying comorbidity, IMV, and sedative/paralytic medications. Further efforts should focus on early recognition and prevention of delirium in COVID-19 patients with these risk profiles.
