Peer-reviewed article
Sedative medications: a potentially modifiable risk factor for improving neurocognitive outcomes after critical illness in infants and children.
GaHyun Byeon A, Mir M, Jerath A, Slessarev M, Lalgudi Ganesan S et al. ·
Summary
Written by AI, not yet AICS's view · claude-haiku-4-5-20251001This review examines how sedative medications used in pediatric intensive care units may affect brain development and cognitive outcomes in critically ill infants and children. The authors find that benzodiazepines are associated with increased delirium and cognitive problems, while alternative medications like dexmedetomidine may offer better outcomes, though more research is needed. The review identifies several potentially modifiable factors—such as choice of sedative, use of multiple sedatives, and sleep disruption—that could be changed to improve long-term brain health. The work acknowledges that other factors like severity of illness and social circumstances also play important roles in these outcomes.
Key points
- Benzodiazepines are linked to increased delirium, sleep fragmentation, withdrawal, and adverse cognitive trajectories in children in intensive care
- α2-adrenergic agonists such as dexmedetomidine may carry lower delirium risk and potential neuroprotective effects, though human evidence in pediatric intensive care is conflicted
- Sedation practices in pediatric intensive care—including drug choice, use of multiple sedatives, sleep disruption, and delirium—are potentially modifiable factors affecting neurocognitive outcomes
- Non-modifiable risk factors include developmental stage at illness onset, acute neurological injury, systemic inflammation, and social determinants of health
- Use of inhaled anesthetics for pediatric intensive care sedation remains understudied despite growing clinical use
Limitations
This is a narrative review that synthesizes existing literature rather than original research, so it cannot provide definitive evidence of causation or measure the magnitude of effects. The review notes that human evidence on alternative sedatives in pediatric intensive care is limited and conflicted, particularly regarding long-term neurocognitive outcomes.
Abstract
Critically ill infants and children often need prolonged sedation to support life-saving therapeutic interventions. Although advances in pediatric intensive care (PICU) have substantially improved survival, an increasing body of evidence indicates that many survivors experience persistent neurocognitive and neurobehavioral impairments. These outcomes arise from a complex interplay between pre-morbid status, critical illness related physiological stressors and iatrogenic exposures during periods of brain development. Evidence consistently links benzodiazepines to increased risk of delirium, sleep fragmentation, withdrawal, and adverse cognitive trajectories in pediatric populations. In contrast, α 2-adrenergic agonists such as dexmedetomidine may be associated with a lower risk of delirium, improved sleep architecture, and potential neuroprotective effects in preclinical and early clinical studies, although human evidence is conflicted with limited data in PICU. Although several studies have evaluated the long-term neurocognitive effects of inhaled anesthetics after general surgical anesthesia, their increasing use for PICU sedation remains understudied. This narrative review synthesizes preclinical and clinical literature examining the associations between sedation practices in PICUs and subsequent neurocognitive outcomes. We focus on potential modifiable contributors, including sedative class selection, sedative polypharmacy, sleep disruption, and delirium, while acknowledging non-modifiable risk factors such as developmental stage at illness onset, acute neurological injury, systemic inflammation, and non-clinical social determinants of health.