Camille Jutras, MD, M.Sc
Pediatric Intensivist
CHU Sainte-Justine, United States
Disclosure information not submitted.
Laurence Ducharme-Crevier, MD, MD MSc (she/her/hers)
Pediatric Intensivist
CHU Sainte Justine. Université de Montréal
Montreal, QC, Canada
Disclosure information not submitted.
Miriam Beauchamp, Phd
neuropsychologist, researcher
CHU Sainte-Justine, Quebec, Canada
Disclosure information not submitted.
Simon Stanworth, MD
Hematologist
John Radcliffe Hospital, Oxford University, England, United Kingdom
Disclosure information not submitted.
Geneviève Du Pont-Thibodeau, MD, MSc
Pediatric-Intensivist
CHU Sainte-Justine, Quebec, Canada
Disclosure information not submitted.
Title: Anemia after Pediatric Critical Illness: Prevalence and Neurocognitive consequences
Introduction/Hypothesis: 50% of PICU survivors are anemic at PICU discharge. Long-term anemia is associated with adverse neurocognitive outcomes in young children. This study aims to determine the prevalence and pathophysiology of anemia in survivors at PICU discharge, and 2 and 6 months later as well as its association with neurocognitive outcomes.
Methods: This is a prospective cohort study of children admitted to the PICU of a tertiary care pediatric hospital. Children with a PICU length of stay ≥4 days requiring invasive mechanical ventilation ≥48 hours or 4 days of non-invasive mechanical ventilation were included. Children born prematurely or requiring cardiac surgery were excluded. Participants underwent bloodwork (complete blood count, iron and inflammation tests) at PICU discharge, and 2 and 6 months post discharge. They also underwent neurocognitive testing at follow-up (depending on age: Brigance Inventory of Early Development II, Wechsler Preschool and Primary Scale ofIntelligence, Wechsler Intelligence Scale for Children V or Wechsler Adult Intelligence Scale IV).
Results: 28 patients were recruited in the study. At PICU discharge, mean age was 3.6±5.4 years; 18/28 (64%) were anemic, 9/19 (47.3%) showed high ferritin level, 18/19 (94.7%) normal iron level, 3/28 (11%) a small MCV, and CRP was high in 7/24 (29%). Two months post discharge, 5/13 (38.4%) patients were still anemic; 1/13 (7.6%) had high ferritin level, 1/12 (8.3%) low iron level, 5/13 (38%) low mean corpuscular volume(MCV), and none had high C-reactive protein (CRP). Six months post discharge, 4/8 (50%) were still anemic, 4/7 (57%) had low iron level, all had normal ferritin, 4/8 had low MCV (50%), and 2/8 (25%) had high CRP. Mean standardized cognitive score for children anemic at PICU discharge was 89±25.7 (median:96) vs. 90.7±16.6 (median:95) for non-anemic children; 9/16 (53%) anemic children had scores less than 1 SD below the mean in one or more neurocognitive domains vs. 3/8 (37.5%) in non-anemic children.
Conclusion: Anemia persists up to 6 months after discharge in more than a third of PICU survivors. Although patients demonstrate signs of inflammation at discharge, this disappears over time. Further research is required to understand the role of anemia on the neurocognitive outcome of these children.