Delirium in children under two years of age admitted to intensive care units – a systematic review

Abstract

Background: Delirium is a state of acute confusion that may arise in people of all ages. Sick infants (children < 12 months old) and children under two years of age are a vulnerable patient group because they are cognitively immature and wholly or partly devoid of verbal language. They are thus dependent on the ability of health professionals and parents or families around them to observe changes in their condition. There is a need for health professionals to increase their knowledge of the prevalence, symptoms, risk factors and observations of delirium in this patient group.

Objective: To shed light on the prevalence, symptoms and observations of delirium in sick infants and children under two years of age admitted to a neonatal or paediatric intensive care unit, and the assessment tools used.

Method: Systematic literature review.

Results: Eight studies were included, with a total of 992 children under two years of age. The prevalence of delirium varied from 8 to 64%. Symptoms of delirium were found to be agitation, confusion, inconsolability, hyperactivity, and altered sleep-wake cycles. Risk factors include respiratory therapy, age < two years and certain medications. Three assessment tools were reviewed: the PreSchool Confusion Assessment Method for the ICU (psCAM-ICU), the Cornell Assessment of Paediatric Delirium (CAPD), and the Paediatric Delirium component (PD scale) of the Sophia Observation Withdrawal Symptoms scale (SOS-PD scale), all with high validity, specicity and sensitivity.

Conclusion: Infants and children under two years of age can develop delirium, but the prevalence is uncertain. Delirium has specic symptoms. Education on the symptoms of delirium and use of assessment tools for health professionals who work in neonatal and paediatric ICUs can help to ensure that delirium is recognised and treated more promptly.