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Abstract

Introduction: Improved survival outcomes of pediatric critical illness have increased the number of children and parents exposed to the stressful environment of the pediatric intensive care unit (PICU). Given the effects of stress on functional outcomes, PICU-related stress is a significant concern. Hypothesis: We hypothesize children and their mothers will demonstrate physiologic, neuroendocrine, and psychological markers of stress during and 1 month after PICU admission. Methods: This is a prospective, longitudinal observational study within a large, urban PICU. Subjects are English- and Spanish- speaking children (ages 8-17 years) admitted with a predicted stay of > 48 hours and their mothers. Exclusion criteria include developmental delay, severe psychiatric disorder, intentional injury, traumatic brain injury, or inability to complete measures. Baseline measures include child’s heart rate, blood pressure, medications (catecholamines, sedation, steroids), and cortisol levels; mother’s cortisol; and measures of acute stress disorder (ASD) [Acute Symptoms Checklist for Children (ASC-Kids); Stanford Acute Stress Reaction Questionnaire (SASRQ)]. Cortisol levels and measures were repeated 1 month after admission. Results: Eight children (Age, M=14 years; 6 male) and their mothers (Age, M=42 years; Spanish-speaking=4) completed the study. Three children received steroids during admission, invalidating their cortisol levels. 60% of the remaining children had significantly elevated cortisol levels (> 20 mcg/dL). At baseline, all children endorsed ASD symptoms and 38% met full criteria. At 1-month follow up, all children still endorsed ASD symptoms, however mean severity scores decreased (9.2 to 4.6), and only 12% met criteria. Among mothers, ASD prevalence and mean severity scores increased from baseline to 1 month (14% to 50% and 7 to 9, respectively). Conclusions: Children and mothers have significantly elevated neuroendocrine markers of stress and ASD symptoms during and after PICU admission. Biobehavioral markers provide a more complete picture of the negative impact of the PICU experience. Future research needs to emphasize early screening of these markers to avoid the adverse effects of stress on functional outcomes.