Long-term outcomes following paediatric sepsis - A narrative review

Introduction: Sepsis is one of leading preventable deaths in the paediatric population. Key focus more recently on intervention and mortality reduction has seen an increase in survival rates. However, knowledge is limited around morbidity associated with sepsis survival.

Objectives: To review and critically appraise the evidence for long-term outcomes in childhood survival of sepsis using the Post-Intensive Care Syndrome – pediatrics (PICS-p) framework.

Methods: A systematic search for studies was undertaken in the electronic databases PubMed and CINAHL from 2010. Studies were eligible for inclusion if they included children (>28 days adjusted age), diagnosed with sepsis, and follow up post hospital discharge using validated outcome measures. Study quality was assessed using the Newcastle Ottawa Scale. The PICS-p subdomains (cognitive, physical, emotional, and social) allowed thematic synthesis of current literature.

Results: Nine studies met review inclusion criteria, involving 2136 children. Thirteen unique outcome measures were identified across the included studies. Follow-up was conducted between 7 days - 12 months post hospital discharge. Physical functioning was the most assessed domain (n= 6, 67%) followed by Cognitive health (n= 2, 22%) and Emotional health (n= 2, 22%). Social health was not explored in any study. Impairments across physical, cognitive, and emotional domains were still evident in studies up to 12 months post discharge.

Conclusion(s): Overall, we identified a wide range of measures, administered at various time points in studies of sepsis survivorship. Variation of follow-up timepoints, validated tools and restricted outcome measures highlighted the lack in understanding of this priority area. Further long-term outcome research is needed to better understand the burden and long-term morbidity in children surviving sepsis.