Pediatric delirium in pediatric intensive care setting: a review of recognition and prevalence

Delirium is defined as an etiologically nonspecific organic cerebral syndrome characterized by concurrent disturbances of consciousness and attention, perception, thinking, memory, psychomotor behavior, emotion, and the sleep-wake schedule. It is typically marked by rapid changes in mental status that fluctuate throughout the day, with the duration being variable and the degree of severity ranging from mild to severe. Unlike adults, pediatric delirium (PD) is often an under-recognized neuropsychiatric disorder in pediatric critical care despite being commonly reported in this population. The prevalence of delirium is estimated at 10-30% in pediatric intensive care units (PICU) and 49-66% in surgical or cardiac PICUs. It is a serious condition in PICU, where critically ill children are exposed to a variety of stressors such as pain, medications, and invasive procedures. PD has been linked to high rates of morbidity and mortality as well as prolonged ICU stays with the consequence of increased hospitalization costs. Patients who are at increased risk of delirium include those with infections, metabolic disorders, hypertension, pain, and medication withdrawal. Younger age groups and underlying developmental delay are also risk factors among children admitted to PICU. The under-diagnosis of this condition in PICU is likely due to a lack of awareness of PD and its overlapping symptoms with other clinical manifestations related to pain, sedation, or withdrawal syndrome, which pose challenges in diagnosing PD accurately. In recent years, several delirium rating scales have been developed and validated as screening tools. Increased use of routine screening improves diagnostic accuracy and implementation of treatment. This review introduces PD and focuses on its prevalence, recognition and brief management in pediatric intensive care setting.

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