Outcomes in infantile and toddler pediatric intensive care unit survivors: Peabody Development Motor Scales – 2
Title: Gross motor developmental dysfunctional outcomes in infantile and toddler pediatric intensive care unit survivors
Purpose: The intent of this study was to research the gross motor development and function in infants and toddlers who survived the PICU.
Study population: The population included 35 patients between the ages of 1 month and <3 years who were hospitalized in the PICU of the First Hospital of Jilin University for greater than 48 hours. Exclusion factors included neuromuscular junction disease, CNS disease, limb fractures, deep vein thrombosis, and patients with gross motor dysfunction prior to being admitted to the PICU.
Methods: The 35 eligible patients were separated into 2 groups based on their score from the Gross Motor Quotient (GMQ). A score of <90 placed the participant in the dysfunction group (n=24). A score of >90 placed the participant in the non-dysfunction group (n=11). The patients were then assessed over their length of stay in the PICU to determine the development of gross motor dysfunction. Researchers recorded age, sex, diagnosis, illness severity, PICU stay length, days on invasive mechanical ventilation (IMV), number of days on methylprednisolone, number of days sedated, number of days on continuous renal replacement therapy (CRRT), and use of vasoactive drugs, all of which were taken into account when determining the relationship between PICU stay and development of gross motor development dysfunction.
Outcome measures: The GMQ was utilized to separate participants into 2 groups – “dysfunction” or “non-dysfunction”. The Age and Stages Questionnaire (ASQ – 3) was used to assess the child’s gross motor development prior to admittance to the PICU. The Pediatric Critical Illness Score (PCIS) was used to assess the severity of the child’s illness. The PDMS – 2 was utilized to assess each participant on discharge from the PICU in order to assess gross motor development function.
Intervention: No interventions were implemented during this study. The research was solely observational.
Results: Among participants in this study, the length of IMV days were longer in children placed in the dysfunction group when compared to the non-dysfunction group. According to this research, it is likely that the use of IMV is related to the development of gross motor dysfunction. IMV typically includes longer PICU stays, increased sedative use and more reliance on invasive examinations, likely resulting in gross motor development delays.
Strengths/limitations: Limitations of this study include a small sample size due to the large number of exclusion criteria. Different measures were also used to assess the child pre-PICU and post-PICU as opposed to being consistent across the length of the study. It could potentially be more beneficial to use a measure such as the PDMS-2 pre-PICU and post-PICU. Some strengths of this study include the robust amount of variables used to determine the relationship between PICU stay and development of gross motor development dysfunction.
Conclusion: Children who are hospitalized in the PICU who also experience long bouts of IMV days are more likely to experience gross motor development dysfunction than children who were not admitted into the PICU.
Reference: Yang CF, Xue Y, Feng JY, Jia FY, Zhang Y, Li YM. Gross motor developmental dysfunctional outcomes in infantile and toddler pediatric intensive care unit survivors. BMC Pediatr. 2019;19(1):508. Published 2019 Dec 21. doi:10.1186/s12887-019-1893-9
2 responses to “Outcomes in infantile and toddler pediatric intensive care unit survivors: Peabody Development Motor Scales – 2”
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Great summary of the article Kaitie! I found it very interesting to read that being admitted to the PICU would be a negative prognostic indicator for gross motor development as mentioned in the conlcusion. I wonder if the exclusion criteria was too strict which narrowed the outcome of the study. I agree with your point of also mentioning that the study only assessed motor development without mentioning other aspects of life such as psychosocial factors . Great job!
Thank you for this insightful article summary. It makes sense that children admitted to the PICU and have IMV tend to experience more gross motor development dysfunction than those that do not. I also appreciated the point on invasive examinations and sedatives. These are factors I didn’t think of right away, but certainly also play a role. I can see the benefit of understanding all these factors for early intervention. As a student of physical therapy I think it is interesting and am curious as to how PT can intervene and hopefully help decrease any gross motor dysfunction through development at that early intervention period.