Paediatric Delirium After Cardiac Surgery:Prevalence and Predictive Risk Factor Analysis

With increasing focus on neurodevelopment in children with congenital heart disease (CHD), early predictive markers are crucial to intervene and improve neurodevelopmental outcome. As postoperative delirium (PD) is known to have a long-term impact on neurocognitive function in adults, investigations into the prevalence and identification of modifiable risk factors of PD offer new perspectives. We conducted a retrospective, single-centre study screening for PD using the Cornell Assessment of Pediatric Delirium (CAPD). We distinguished it from the iatrogenic withdrawal syndrome (IWS) using the withdrawal assessment tool 1 (WAT-1). An explorative, multivariate regression analysis included various pre-, intra-, and postoperative variables. With screening compliance of 95% in 311 patients, PD prevalence was 40.2%, and 46.4% developed IWS. Infants were at highest risk for PD (OR 2.9, p = 0.05). Prolonged mechanical ventilation > 100hours (OR 7.4, p = 0.003), infusion therapy with ketamine (OR 3.3, p = 0.009), IWS (mild: OR 7.7, p = < 0.001, severe: OR 17.0, p = < 0.001) and low cardiac output syndrome (LCOS) (OR 3.9, p = 0.02) were significant predictive risk factors for PD. Overall, PD and IWS are highly prevalent in paediatric cardiac intensive care unit (pCICU), especially in infants and children with prolonged ventilation duration, demand for multiple sedatives, and LCOS as a newly described risk factor.