Severe bacterial infections requiring PICU admission in previously healthy children – Insights from a structured pediatric intensive care follow-up program

Severe bacterial infections requiring PICU admission in previously healthy children – Insights from a structured pediatric intensive care follow-up program | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Short Report Severe bacterial infections requiring PICU admission in previously healthy children – Insights from a structured pediatric intensive care follow-up program Sarah Goretzki, Clara Held, Sebastian Tschirner, Christina Pentek, and 9 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8155821/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Objective This study aimed to evaluate physical, cognitive, and psychosocial outcomes in previously healthy children admitted to the Pediatric Intensive Care Unit (PICU) with severe complications arising from initially common community-acquired infections, and to describe the first-year experience of a structured post-intensive care follow-up program at a tertiary care hospital in Germany. Currently Germany lacks standardized follow-up structures for PICU survivors, despite growing recognition of long-term morbidity. Design: Clinical and follow-up data were obtained retrospectively from in- and outpatient medical records of all PICU patients meeting inclusion criteria during the study period. Demographic, clinical, and follow-up data were extracted anonymously. Multidomain outcomes were assessed at 4 weeks, 3, 6, and 12 months after discharge, including physical, neurocognitive, and psychosocial parameters. Setting: Tertiary care University center in Germany. Patients: All previously healthy children (n = 37, age > 28 days and < 18 years) admitted to the PICU in 2023 due to severe infectious complications, including intracranial abscess or meningitis (43%), orbital abscesses (27%), septic shock (14%), osteomyelitis (11%), and necrotizing fasciitis (5%). Interventions: None. Measurements and Main Results: Despite appropriate acute management during the PICU stay, 25 children (68%) developed prolonged neurological, somatic, or psychosocial impairments, including motor deficits, neurocognitive dysfunction, and anxiety. Many sequelae emerged around 5 months after discharge. The heterogeneous recovery trajectories emphasize the clinical relevance of Pediatric Post-Intensive Care Syndrome (PICS-p). Conclusions Our findings highlight the need for multidisciplinary post-PICU follow-up, particularly for previously healthy children. Early recognition and targeted interventions may reduce long-term morbidity and improve quality of life for affected children and their families. Pediatrics Invasive streptococcal infections pediatric post-intensive care syndrome (PICS-p) post-intensive care syndrome family (PICS-F) neurocognitive outcome multidisciplinary care Figures Figure 1 Figure 2 Introduction Over the past decades, advances in pediatric intensive care medicine have led to a substantial decline in mortality rates ( 1 ). As survival rates continue to improve, clinical and research attention has shifted towards the long-term morbidity and health-related quality of life of survivors. Up to 80% of children discharged from the PICU develop new or persistent physical, cognitive, psychological, or social impairments ( 2 , 3 ). The Pediatric Post-Intensive Care Syndrome (PICS-p) describes newly acquired or worsening impairments after PICU admission, while PICS-F affects parents and siblings ( 4 ). These concepts suggest the importance of structured, multidisciplinary follow-up ( 5 ). While most bacterial infections in childhood are benign and self-limiting, life-threatening complications such as sepsis, intracranial abscess, necrotizing fasciitis, or osteomyelitis can arise even in previously healthy children ( 6 – 8 ). They may experience substantial long-term sequelae after PICU discharge ( 4 , 9 ). This brief report presents a single-center assessment of structured follow-up in children admitted to the PICU in 2023 due to severe complications from bacterial infections. Methods This was a retrospective, single-center study conducted at a tertiary care children’s hospital. Children > 28 days and < 18 years admitted to the PICU in 2023 due to complications of community-acquired ENT or soft-tissue infections were included. Anonymized findings following the implementation of a structured post-intensive care follow-up program were included, covering the entire inpatient course, including known risk factors for PICS-p (e.g. length of stay, sepsis, vasoactive agents, ventilation, sedation and delirium) (Fig. 1). Multidomain outcomes were assessed at 4 weeks, 3 months, 6 months, and 12 months after hospital discharge and included physical, neurocognitive, and psychosocial aspects (using among others Bayley Scales of Infant Development testing, Wechsler Intelligence Scale for Children-V (WISC-V) ), via somatic follow up (specialist pediatric comprehensive examination with neuro-pediatric focus) as well as standardized questionnaires using published cut-off scores ( Inventory for the Assessment of Quality of Life in Children and Adolescents (ILK), Beck Anxiety Inventory for Youth (BAI-Y), Body Self-Perception Inventory for Youth (BSCI-Y) , physiotherapeutic evaluations, and psychological assessments (Table 2). Descriptive analyses were performed. Continuous variables are presented as median (IQR) and categorical variables as n (%). Results A total of 37 children fulfilled the inclusion criteria. The median age at admission was 8 years (IQR 1–11.5), and 61% were female. All patients had been previously healthy before PICU admission. The primary infectious foci were ENT infections (n = 27; 73%) and soft-tissue infections (n = 10; 27%). The most common complications leading to PICU admission were intracranial abscess or bacterial meningitis (n = 17; 43%), retro-orbital abscess (n = 10; 27%), septic shock (n = 5; 14%; including three toxic shock syndromes), osteomyelitis (n = 4; 11%), and necrotizing fasciitis (n = 1; 5% (Table 1, Fig. 1). Pathogen detection revealed Streptococcus spp. in 18 (29%), Staphylococcus aureus in 9 (24%), and other bacteria in 10 (27%) cases, including atypical Mycobacteria (n = 2; 5%), Klebsiella spp. (n = 1; 3%), Mycoplasma (n = 1, 3%), and six cases without an identified pathogen. Targeted antimicrobial therapy was received by 95% and 32 (87%) required surgical source control (Table 1). The median PICU stay was 4 days (Interquartile range (IQR) 2–5). Mechanical ventilation was performed in 30 (81%) patients for a median duration of 1 day (IQR 1–2). Vasoactive support was administered in 14 (38%), and sedation was administered in 30 (81%), half of which showed signs of delirium. All patients survived, with long-term sequelae affecting 25 (68%). The most frequent neurological or functional impairments included motor deficits (27%), hearing impairment (27%), migraine requiring new long-term medication (27%), and visual impairment (22%). Seizures, developmental regression, and attention deficits each occurred in one-quarter of cases (Table 2). The Pediatric Cerebral Performance Category Scale (PCPC) worsened by a median of 1 (IQR 0–1). Beyond physical impairment, psychological and cognitive difficulties also became evident during follow-up. Depression or anxiety was documented in 9 (24%) children, and 8 (22%) received support for attention or concentration problems, leading to school-related difficulties such as a decline in grades by at least one level, repetition of a school year, transfer to a different type of school, or even the need for an integration assistant. Inpatient rehabilitation was initiated in 17 (46%) and many required outpatient therapies like occupational therapy (49%), physiotherapy (38%), referral to a psychologist (32%), and speech therapy (22%). Medication after discharge was needed in 13 (35%) (Table 2). The attendance at 4 weeks, 3 months, 6 months, and 12 months (Fig. 1) declined from 81% at Visit 1 to 62% after 1 year. The main reasons for missed visits were ongoing inpatient rehabilitation (n = 3), no further need for follow-up (n = 4), family relocation (n = 3), and non-attendance (n = 4). Additional follow-up visits were required in 11 (30%) patients to address ongoing issues (Table 2). In 22 children (59%), difficulties in diagnostic coding led to delays or denials in reimbursement for required therapies, particularly affecting access to specialized inpatient rehabilitation (13/17; 45%), where the absence of a specific ICD-10 code for PICS-p frequently necessitated additional justification (Table 2). Discussion This single-center analysis found that initially benign bacterial infections that progress to severe or even life-threatening complications can cause long-term morbidity in previously healthy children. The predominance of Streptococcus spp. corresponds to the surge of invasive streptococcal infections reported in 2023 across Europe and North America, likely reflecting post-pandemic changes in population immunity and pathogen transmission dynamics ( 10 ). A large proportion of children surviving intensive care develop persistent sequelae despite short PICU stays and often mild organ dysfunction. These include motor and sensory deficits, neurocognitive changes, and psychosocial difficulties, consistent with the multidimensional concept of pediatric Post-Intensive Care Syndrome (PICS-p) ( 2 ). A recent meta-analysis showed reduced cognitive performance and post-traumatic stress even without primary neurological injury ( 3 ). It is assumed that post-critical illness morbidity is common, under-recognized, and influenced by factors such as sedation, delirium, pain, and stress during the PICU stay ( 11 ). Emerging frameworks, like that described by Manning et al., conceptualize PICS-p as encompassing physical, cognitive, and psychosocial domains ( 12 ). Our findings support this model: many psychosocial and cognitive sequelae emerged months after hospital discharge, typically between three and six months, showing limits of early outcome assessments. Similar findings support structured follow-up, yet its implementation remains inconsistent ( 13 ). The structured post-PICU follow-up in our cohort achieved high overall attendance, with 81% attendance at four weeks and 62% at one year, demonstrating its clinical feasibility. Approximately 30% of patients required additional visits between scheduled visits or after the 12-month assessment, underscoring the need for flexible follow-up intervals. Integrating psychological, physiotherapeutic, and educational support proved crucial for early detection and intervention in our follow-up program. Our data suggest that even children with severe but non-life-threatening illness benefit from systematic follow-up, as subtle morbidity often became apparent only after school or social reintegration. This aligns with international calls to shift the focus from short-term survival to long-term functional and psychosocial outcomes ( 13 ). Limitations include the retrospective, single-center design and modest sample size, which limit generalizability. Moreover, a detailed characterization of this patient population is essential from both a health-services and health-economics perspective. Although a dedicated ICD-10/ICD-10-CM or ICD-10-GM diagnostic code for PICS in children is currently under discussion (in Germany), it has not yet been introduced. Consequently, long-term sequelae are frequently captured only through non-specific symptom codes or general “Z-codes,” complicating standardized reporting and resource planning ( 14 ). At the same time, international studies show that children surviving critical illness frequently experience persistent physical, cognitive, psychosocial, and educational impairments, yet remain insufficiently integrated into rehabilitation and support services. A recent narrative review on pediatric post-intensive care syndrome (PICS-p) highlights that, although such impairments are well documented, “no standardized or evidence-based approach to long-term follow-up in the PICU exists” ( 5 ). These findings underscore that PICS-p extends beyond medical recovery and requires coordinated care across multiple systems. The lack of a specific ICD-10 code for pediatric PICS, may have contributed to funding and reimbursement challenges for multidisciplinary rehabilitation. As a result, families frequently encountered administrative delays, highlighting the urgent need for standardized coding and better integration of post-PICU care pathways to prevent loss to follow-up and unmet care needs. Our findings therefore support the development of a multiprofessional post-ICU follow-up model to address these structural gaps and to ensure that children and families receive appropriate, continuous and equitable care across the entire recovery trajectory. Conclusion This single-center analysis demonstrates that structured follow-up for pediatric intensive care survivors is both feasible and valuable. Even previously healthy children admitted for short PICU stays due to common infections may face relevant long-term sequelae. Multidisciplinary post-PICU care enabled early detection of neurological, functional, and psychosocial impairments and was well accepted. These findings support systematic follow-up to all PICU survivors, while multicenter prospective studies should define optimal screening strategies to identify PICS-p and improve long-term outcomes. Declarations Ethical approval This study was conducted in accordance with the Declaration of Helsinki. The study protocol was approved by the Ethics Committee of the University of Duisburg-Essen (approval number 25-12803-BO), which waived the requirement for informed consent due to the retrospective nature of the study. The study is registered in the German Clinical Trials Register (DRKS) under the identifier DRKS00038522. Acknowledgment We would like to express our sincere gratitude to all patients and their families for putting their trust in our care. We thank the nursing and medical staff of the Department of Pediatrics I at the University Hospital Essen for their dedicated support in patient care and sample collection. Conflicts of interest / funding: The authors declare no conflict of interest. Author Contributions: N.B., C.D.S. and S.C.G. conceptualized the study. S.G., C.H., S.T., H.K., A.D.M., N.S., A.G., M.K., H.R., S.B collected data. S.C.G. performed data curation and analysis. S.C.G., C.H., S.T. and S.B. helped by literature review, C. D.-S., S.B., U. S.-S., U. F.-M, and N.B. supervised the project. S.C.G. drafted the manuscript, and all authors reviewed and approved the final version References Procter C, Morrow B, Pienaar G, Shelton M, Argent A (2021) Outcomes following admission to paediatric intensive care: a systematic review. J Paediatr Child Health 57(3):328–358. 10.1111/jpc.15381 Manning JC, Pinto NP, Rennick JE et al (2020) Conceptualizing post intensive care syndrome in children: the PICS-p framework. Pediatr Crit Care Med 21(7):e491–e498 Ko MSM, Poh PF, Heng KYC et al (2022) Assessment of long-term psychological outcomes after pediatric intensive care unit admission: a systematic review and meta-analysis. JAMA Pediatr 176(3):e215767. 10.1001/jamapediatrics.2021.5767 Smith AC, Ferguson HN, Russell RM, Savsani P, Wang S (2025) Post-Intensive Care Syndrome Family. Crit Care Clin 41(1):73–88. 10.1016/j.ccc.2024.08.008 Quadir A, Festa M, Gilchrist M, Thompson K, Pride N, Basu S (2024) Long-term follow-up in pediatric intensive care: a narrative review. Front Pediatr 12:1430581. 10.3389/fped.2024.1430581 Cress VJ, Green KJ, Jain A, Viaud-Murat EM, Patel PA, Wiedermann JP (2024) A scoping review of the intracranial complications of pediatric sinusitis. Otolaryngol Head Neck Surg 171(4):937–945. 10.1002/ohn.862 Shinnawi S, Khoury M, Cohen-Vaizer M, Cohen JT, Gordin A (2024) Intracranial complications of acute mastoiditis: surgery not always necessary. Am J Otolaryngol 45(4):104299. 10.1016/j.amjoto.2024.104299 Peltola H, Pääkkönen M (2014) Acute osteomyelitis in children. N Engl J Med 370(4):352–360. 10.1056/NEJMra1213956 Pollack MM, Holubkov R, Funai T et al (2014) Pediatric intensive care outcomes: development of new morbidities during pediatric critical care. 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Anaesth Crit Care Pain Med 43(4):101401. 10.1016/j.accpm.2024.101401 Peach BC, Valenti M, Sole ML et al (2021) A Call for the World Health Organization to Create International Classification of Disease Diagnostic Codes for Post-Intensive Care Syndrome in the Age of COVID-19. World Med Health Policy 13(2):373–382. 10.1002/wmh3.401 Tables Table 1 Patient Characteristics, Sequalaes and PICU-Follow-Up Variable n (%) or Median (IQR) Demographics Age at admission, years, median (IQR) 8 ( 1 – 11 , 5 ) Female 22 (61%) Previously healthy before infection 37 (100%) Primary infectious focus Ear-Nose-Throat-Infection 27 (73%) Soft-Tissue-Infection (incl. cellulitis and phlegmone) 10 (27%) Primary infectious complication leading to PICU admission Intracranial abscess / bacterial meningitis 17 (43%) Retro-orbital abscess 10 (27%) Septic shock (incl. toxic shock syndrome) 5 (14%) Osteomyelitis 4 (11%) Necrotizing fasciitis 1 (5%) Pathogens identified Streptococcus spp. 18 (49%) Streptococcus pyogens 13 (35%) Streptococcus pneumoniae 1 (3%) Streptococcus intermedius 4 (11%) Staphylococcus aureus 9 (24%) Other bacteria* 10 (27%) PICU course Antimicrobial therapy 35 (95%) Surgical source control (drainage/debridement) 32 (87%) Length of PICU stay, days, median (IQR) 4 ( 2 – 5 ) Mechanical ventilation 30 (81%) Length of mechanical ventilation, days, median (IQR) 1 ( 1 – 2 ) Vasoactive support 14 (38%) Duration of vasoactive support, days, median (IQR) 1 (1–3.5) Sedative medication 30 (81%) Sedation duration, days, median (IQR) 2 ( 1 – 4 ) Delirium 12 (32%) Overall Outcome PCPC change (from admission to discharge), median (IQR) 1 (0–1) PCPC before admission, median (IQR) 1 ( 1 – 1 ) PCPC after admission, median (IQR) 2 ( 1 – 2 ) Mortality 0 (0%) Sequelae 25 (68%) Time to diagnosis of sequelae, month, median (IQR) 5 ( 1 – 3 ) Specific sequelae Seizures (newly diagnosed after discharge) 8 (22%) Newly diagnosed migraine (needing medication) 10 (27%) Motor deficits (physiotherapeutic assessment, necessity of aids) 10 (27%) Visual impairment (ophthalmologically confirmed) 8 (22%) Hearing impairment (decrease in audiogram) 10 (27%) Developmental regression or lack of developmental progress (psychological and pediatric assessment using among others Bayley Scales of Infant Development testing and WISC-V) 10 (27%) Attention deficits (needing therapy/medication, school difficulties 8 (22%) Depression, anxiety (psychological evaluated and need for therapy - previously screened using ILK, BAI-Y, TEX-Q) 9 (24%) Therapies Inpatient rehabilitation 17 (46%) Referral to psychologist 12 (32%) Referral to physiotherapy 14 (38%) Referral to occupational therapy 18 (49%) Referral to speech therapy 8 (22%) Medication after discharge 13 (35%) Others** 7 (19%) Difficulties within coding resulting funding challenges All therapies 22 (59%) Inpatient rehabilitation 13 / 17 (45%) Follow-up attendence and continuity*** Attended Post-PICU Visit 1 (≈ 4 weeks) 30 (81%) Attended Post-PICU Visit 2 (≈ 3 months) 25 (68%) Attended Post-PICU Visit 3 (≈ 6 months) 23 (62%) Attended Post-PICU Visit 4 (≈ 12 months) 23 (62%) Additional visits (between standard visits) 11 (30%) *Others included atypical mycobacteria (n = 2), Klebsiella spp. (n = 1), mycoplasma (n = 1), unknown pathogen (n = 6); **Others: plastic issues (4), partial limp loss (2), chronic pain (1), Cochlea implant (1); *** Reasons for not attendance: still in inpatient rehabilitation (3), no further need for follow-up (4), family moved away (3), incompliance/missed appointments (4); Abbreviation: BAI-Y = Beck Anxiety Inventory for Youth; BSCI-Y = Body Self-Perception Inventory for Youth; ILK = Quality of Life in Children and Adolescents; PCPC = Pediatric Cerebral Performance Category Scale; PICU = Paediatric Intensive Care Unit; Streptococcus spp. = Streptococcus species; TEX-Q = Therapy Expectation Questionnaire; WISC-V = Wechsler Intelligence Scale for Children-V Table 2 Overview of the standardized multidomain follow-up test battery used within the structured post-PICU follow-up program. Assessments were age-adapted and administered by trained pediatric neurologists, psychologists, and physiotherapists. Domain Assessment Tools / Methods Purpose / Outcome Measured Months After Discharge Physical / Somatic Function Comprehensive pediatric examination with neuro-pediatric focus; as well as physiotherapeutic assessment Motor deficits, muscle tone, coordination, residual neurological impairment, pain, developmental state 1, 3, 6, 12 Neurocognitive Development Bayley Scales of Infant and Toddler Development (for < 3 years); Wechsler Intelligence Scale for Children – V (WISC-V, for ≥ 6 years) Global and domain-specific cognitive performance; developmental progress or regression 3, 6, 12 Psychological / Emotional Function Beck Anxiety Inventory for Youth (BAI-Y); Inventory for the Assessment of Quality of Life in Children and Adolescents (ILK) Anxiety symptoms, depression, health-related quality of life 3, 6, 12 Body Image / Self-Perception Body Self-Perception Inventory for Youth (BSCI-Y) Self-esteem, perception of physical changes after illness 6, 12 Therapy Motivation / Expectation Therapy Expectation Questionnaire (TEX-Q) Patient and family expectations and satisfaction regarding rehabilitation and follow-up care 3, 12 Family / Psychosocial Impact Semi-structured family interviews and psychologist evaluation Family functioning, parental stress, PICS-F screening 6, 12 Additional Declarations The authors declare no competing interests. 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08:20:44","extension":"html","order_by":8,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":77040,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-8155821/v1/151e0bfb2e76719974838f07.html"},{"id":96367511,"identity":"57a76140-3232-485f-8af0-1c62ca7661ff","added_by":"auto","created_at":"2025-11-20 10:12:57","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":193274,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eTimeline of structured post-PICU follow-up visits over 12 months\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-8155821/v1/95591a831402148d714db51c.png"},{"id":96355964,"identity":"eb5def42-3ee6-4302-bf35-a62a01b5f3bd","added_by":"auto","created_at":"2025-11-20 08:20:44","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":171841,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eInfectious Complications and Follow-Up Attendance\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-8155821/v1/9dfc80abaad5f000e0373519.png"},{"id":96369458,"identity":"82b005e6-5e49-496b-8b33-29fa1dea476d","added_by":"auto","created_at":"2025-11-20 10:21:01","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1036302,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8155821/v1/69a5d1ae-29c3-48a5-a8bc-690866b34657.pdf"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"\u003cp\u003e\u003cstrong\u003eSevere bacterial infections requiring PICU admission in previously healthy children – Insights from a structured pediatric intensive care follow-up program\u003c/strong\u003e\u003c/p\u003e","fulltext":[{"header":"Introduction","content":"\u003cp\u003eOver the past decades, advances in pediatric intensive care medicine have led to a substantial decline in mortality rates (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). As survival rates continue to improve, clinical and research attention has shifted towards the long-term morbidity and health-related quality of life of survivors. Up to 80% of children discharged from the PICU develop new or persistent physical, cognitive, psychological, or social impairments (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe Pediatric Post-Intensive Care Syndrome (PICS-p) describes newly acquired or worsening impairments after PICU admission, while PICS-F affects parents and siblings (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e). These concepts suggest the importance of structured, multidisciplinary follow-up (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eWhile most bacterial infections in childhood are benign and self-limiting, life-threatening complications such as sepsis, intracranial abscess, necrotizing fasciitis, or osteomyelitis can arise even in previously healthy children (\u003cspan additionalcitationids=\"CR7\" citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). They may experience substantial long-term sequelae after PICU discharge (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThis brief report presents a single-center assessment of structured follow-up in children admitted to the PICU in 2023 due to severe complications from bacterial infections.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eThis was a retrospective, single-center study conducted at a tertiary care children\u0026rsquo;s hospital. Children\u0026thinsp;\u0026gt;\u0026thinsp;28 days and \u0026lt;\u0026thinsp;18 years admitted to the PICU in 2023 due to complications of community-acquired ENT or soft-tissue infections were included. Anonymized findings following the implementation of a structured post-intensive care follow-up program were included, covering the entire inpatient course, including known risk factors for PICS-p (e.g. length of stay, sepsis, vasoactive agents, ventilation, sedation and delirium) (Fig.\u0026nbsp;1). Multidomain outcomes were assessed at 4 weeks, 3 months, 6 months, and 12 months after hospital discharge and included physical, neurocognitive, and psychosocial aspects (using among others \u003cem\u003eBayley Scales of Infant Development testing, Wechsler Intelligence Scale for Children-V (WISC-V)\u003c/em\u003e), via somatic follow up (specialist pediatric comprehensive examination with neuro-pediatric focus) as well as standardized questionnaires using published cut-off scores (\u003cem\u003eInventory for the Assessment of Quality of Life in Children and Adolescents (ILK), Beck Anxiety Inventory for Youth (BAI-Y), Body Self-Perception Inventory for Youth (BSCI-Y)\u003c/em\u003e, physiotherapeutic evaluations, and psychological assessments (Table\u0026nbsp;2).\u003c/p\u003e\u003cp\u003eDescriptive analyses were performed. Continuous variables are presented as median (IQR) and categorical variables as n (%).\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e A total of 37 children fulfilled the inclusion criteria. The median age at admission was 8 years (IQR 1\u0026ndash;11.5), and 61% were female. All patients had been previously healthy before PICU admission.\u003c/p\u003e\u003cp\u003eThe primary infectious foci were ENT infections (n\u0026thinsp;=\u0026thinsp;27; 73%) and soft-tissue infections (n\u0026thinsp;=\u0026thinsp;10; 27%). The most common complications leading to PICU admission were intracranial abscess or bacterial meningitis (n\u0026thinsp;=\u0026thinsp;17; 43%), retro-orbital abscess (n\u0026thinsp;=\u0026thinsp;10; 27%), septic shock (n\u0026thinsp;=\u0026thinsp;5; 14%; including three toxic shock syndromes), osteomyelitis (n\u0026thinsp;=\u0026thinsp;4; 11%), and necrotizing fasciitis (n\u0026thinsp;=\u0026thinsp;1; 5% (Table\u0026nbsp;1, Fig.\u0026nbsp;1).\u003c/p\u003e\u003cp\u003ePathogen detection revealed Streptococcus spp. in 18 (29%), \u003cem\u003eStaphylococcus aureus\u003c/em\u003e in 9 (24%), and other bacteria in 10 (27%) cases, including atypical Mycobacteria (n\u0026thinsp;=\u0026thinsp;2; 5%), Klebsiella spp. (n\u0026thinsp;=\u0026thinsp;1; 3%), Mycoplasma (n\u0026thinsp;=\u0026thinsp;1, 3%), and six cases without an identified pathogen. Targeted antimicrobial therapy was received by 95% and 32 (87%) required surgical source control (Table\u0026nbsp;1).\u003c/p\u003e\u003cp\u003eThe median PICU stay was 4 days (Interquartile range (IQR) 2\u0026ndash;5). Mechanical ventilation was performed in 30 (81%) patients for a median duration of 1 day (IQR 1\u0026ndash;2). Vasoactive support was administered in 14 (38%), and sedation was administered in 30 (81%), half of which showed signs of delirium.\u003c/p\u003e\u003cp\u003eAll patients survived, with long-term sequelae affecting 25 (68%). The most frequent neurological or functional impairments included motor deficits (27%), hearing impairment (27%), migraine requiring new long-term medication (27%), and visual impairment (22%). Seizures, developmental regression, and attention deficits each occurred in one-quarter of cases (Table\u0026nbsp;2). The Pediatric Cerebral Performance Category Scale (PCPC) worsened by a median of 1 (IQR 0\u0026ndash;1).\u003c/p\u003e\u003cp\u003eBeyond physical impairment, psychological and cognitive difficulties also became evident during follow-up. Depression or anxiety was documented in 9 (24%) children, and 8 (22%) received support for attention or concentration problems, leading to school-related difficulties such as a decline in grades by at least one level, repetition of a school year, transfer to a different type of school, or even the need for an integration assistant. Inpatient rehabilitation was initiated in 17 (46%) and many required outpatient therapies like occupational therapy (49%), physiotherapy (38%), referral to a psychologist (32%), and speech therapy (22%). Medication after discharge was needed in 13 (35%) (Table\u0026nbsp;2).\u003c/p\u003e\u003cp\u003eThe attendance at 4 weeks, 3 months, 6 months, and 12 months (Fig.\u0026nbsp;1) declined from 81% at Visit 1 to 62% after 1 year. The main reasons for missed visits were ongoing inpatient rehabilitation (n\u0026thinsp;=\u0026thinsp;3), no further need for follow-up (n\u0026thinsp;=\u0026thinsp;4), family relocation (n\u0026thinsp;=\u0026thinsp;3), and non-attendance (n\u0026thinsp;=\u0026thinsp;4). Additional follow-up visits were required in 11 (30%) patients to address ongoing issues (Table\u0026nbsp;2).\u003c/p\u003e\u003cp\u003eIn 22 children (59%), difficulties in diagnostic coding led to delays or denials in reimbursement for required therapies, particularly affecting access to specialized inpatient rehabilitation (13/17; 45%), where the absence of a specific ICD-10 code for PICS-p frequently necessitated additional justification (Table\u0026nbsp;2).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eThis single-center analysis found that initially benign bacterial infections that progress to severe or even life-threatening complications can cause long-term morbidity in previously healthy children.\u003c/p\u003e\u003cp\u003eThe predominance of Streptococcus spp. corresponds to the surge of invasive streptococcal infections reported in 2023 across Europe and North America, likely reflecting post-pandemic changes in population immunity and pathogen transmission dynamics (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eA large proportion of children surviving intensive care develop persistent sequelae despite short PICU stays and often mild organ dysfunction. These include motor and sensory deficits, neurocognitive changes, and psychosocial difficulties, consistent with the multidimensional concept of pediatric Post-Intensive Care Syndrome (PICS-p) (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). A recent meta-analysis showed reduced cognitive performance and post-traumatic stress even without primary neurological injury (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). It is assumed that post-critical illness morbidity is common, under-recognized, and influenced by factors such as sedation, delirium, pain, and stress during the PICU stay (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eEmerging frameworks, like that described by Manning et al., conceptualize PICS-p as encompassing physical, cognitive, and psychosocial domains (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). Our findings support this model: many psychosocial and cognitive sequelae emerged months after hospital discharge, typically between three and six months, showing limits of early outcome assessments. Similar findings support structured follow-up, yet its implementation remains inconsistent (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eThe structured post-PICU follow-up in our cohort achieved high overall attendance, with 81% attendance at four weeks and 62% at one year, demonstrating its clinical feasibility. Approximately 30% of patients required additional visits between scheduled visits or after the 12-month assessment, underscoring the need for flexible follow-up intervals.\u003c/p\u003e\u003cp\u003eIntegrating psychological, physiotherapeutic, and educational support proved crucial for early detection and intervention in our follow-up program. Our data suggest that even children with severe but non-life-threatening illness benefit from systematic follow-up, as subtle morbidity often became apparent only after school or social reintegration. This aligns with international calls to shift the focus from short-term survival to long-term functional and psychosocial outcomes (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eLimitations include the retrospective, single-center design and modest sample size, which limit generalizability. Moreover, a detailed characterization of this patient population is essential from both a health-services and health-economics perspective. Although a dedicated ICD-10/ICD-10-CM or ICD-10-GM diagnostic code for PICS in children is currently under discussion (in Germany), it has not yet been introduced. Consequently, long-term sequelae are frequently captured only through non-specific symptom codes or general \u0026ldquo;Z-codes,\u0026rdquo; complicating standardized reporting and resource planning (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eAt the same time, international studies show that children surviving critical illness frequently experience persistent physical, cognitive, psychosocial, and educational impairments, yet remain insufficiently integrated into rehabilitation and support services. A recent narrative review on pediatric post-intensive care syndrome (PICS-p) highlights that, although such impairments are well documented, \u0026ldquo;no standardized or evidence-based approach to long-term follow-up in the PICU exists\u0026rdquo; (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). These findings underscore that PICS-p extends beyond medical recovery and requires coordinated care across multiple systems. The lack of a specific ICD-10 code for pediatric PICS, may have contributed to funding and reimbursement challenges for multidisciplinary rehabilitation. As a result, families frequently encountered administrative delays, highlighting the urgent need for standardized coding and better integration of post-PICU care pathways to prevent loss to follow-up and unmet care needs.\u003c/p\u003e\u003cp\u003e Our findings therefore support the development of a multiprofessional post-ICU follow-up model to address these structural gaps and to ensure that children and families receive appropriate, continuous and equitable care across the entire recovery trajectory.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis single-center analysis demonstrates that structured follow-up for pediatric intensive care survivors is both feasible and valuable. Even previously healthy children admitted for short PICU stays due to common infections may face relevant long-term sequelae. Multidisciplinary post-PICU care enabled early detection of neurological, functional, and psychosocial impairments and was well accepted. These findings support systematic follow-up to all PICU survivors, while multicenter prospective studies should define optimal screening strategies to identify PICS-p and improve long-term outcomes.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthical approval\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was conducted in accordance with the Declaration of Helsinki. The study protocol was approved by the Ethics Committee of the University of Duisburg-Essen (approval number 25-12803-BO), which waived the requirement for informed consent due to the retrospective nature of the study. The study is registered in the German Clinical Trials Register (DRKS) under the identifier DRKS00038522.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgment\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe would like to express our sincere gratitude to all patients and their families for putting their trust in our care. We thank the nursing and medical staff of the Department of Pediatrics I at the University Hospital Essen for their dedicated support in patient care and sample collection.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflicts of interest / funding:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare no conflict of interest.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eN.B., C.D.S. and S.C.G. conceptualized the study. S.G., C.H., S.T., H.K., A.D.M., N.S., A.G., M.K., H.R., S.B collected data. S.C.G. performed data curation and analysis. S.C.G., C.H., S.T. and S.B. helped by literature review, C. D.-S., S.B., U. S.-S., U. F.-M, and N.B. supervised the project. S.C.G. drafted the manuscript, and all authors reviewed and approved the final version\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eProcter C, Morrow B, Pienaar G, Shelton M, Argent A (2021) Outcomes following admission to paediatric intensive care: a systematic review. J Paediatr Child Health 57(3):328\u0026ndash;358. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1111/jpc.15381\u003c/span\u003e\u003cspan address=\"10.1111/jpc.15381\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eManning JC, Pinto NP, Rennick JE et al (2020) Conceptualizing post intensive care syndrome in children: the PICS-p framework. 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Otolaryngol Head Neck Surg 171(4):937\u0026ndash;945. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1002/ohn.862\u003c/span\u003e\u003cspan address=\"10.1002/ohn.862\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eShinnawi S, Khoury M, Cohen-Vaizer M, Cohen JT, Gordin A (2024) Intracranial complications of acute mastoiditis: surgery not always necessary. Am J Otolaryngol 45(4):104299. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.amjoto.2024.104299\u003c/span\u003e\u003cspan address=\"10.1016/j.amjoto.2024.104299\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePeltola H, P\u0026auml;\u0026auml;kk\u0026ouml;nen M (2014) Acute osteomyelitis in children. N Engl J Med 370(4):352\u0026ndash;360. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1056/NEJMra1213956\u003c/span\u003e\u003cspan address=\"10.1056/NEJMra1213956\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePollack MM, Holubkov R, Funai T et al (2014) Pediatric intensive care outcomes: development of new morbidities during pediatric critical care. Pediatr Crit Care Med 15(9):821\u0026ndash;827\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eValcarcel Salamanca B, Cyr PR, Bentdal YE, Watle SV, Wester AL, Strand \u0026Aring;MW, B\u0026oslash;\u0026aring;s H (2024) Increase in invasive group A streptococcal infections (iGAS) in children and older adults, Norway, 2022 to 2024. Euro Surveill 29(20):2400242. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.2807/1560-7917.ES.2024.29.20.2400242\u003c/span\u003e\u003cspan address=\"10.2807/1560-7917.ES.2024.29.20.2400242\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eWoodruff AG, Choong K (2021) Long-term outcomes and the post-intensive care syndrome in critically ill children: a North American perspective. Child (Basel) 8(4):254. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3390/children8040254\u003c/span\u003e\u003cspan address=\"10.3390/children8040254\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eTang M, Xu M, Su S, Huang X, Zhang S (2021) Post-intensive care syndrome in children: a concept analysis. J Pediatr Nurs 61:417\u0026ndash;423. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.pedn.2021.10.007\u003c/span\u003e\u003cspan address=\"10.1016/j.pedn.2021.10.007\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eMortamet G, Birsan S, Zini J et al (2024) Pediatric intensive care unit follow-up: thinking before acting. Anaesth Crit Care Pain Med 43(4):101401. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.accpm.2024.101401\u003c/span\u003e\u003cspan address=\"10.1016/j.accpm.2024.101401\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003ePeach BC, Valenti M, Sole ML et al (2021) A Call for the World Health Organization to Create International Classification of Disease Diagnostic Codes for Post-Intensive Care Syndrome in the Age of COVID-19. World Med Health Policy 13(2):373\u0026ndash;382. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1002/wmh3.401\u003c/span\u003e\u003cspan address=\"10.1002/wmh3.401\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"},{"header":"Tables","content":"\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cdiv class=\"SimplePara\"\u003ePatient Characteristics, Sequalaes and PICU-Follow-Up\u003c/div\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"2\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cdiv class=\"SimplePara\"\u003eVariable\u003c/div\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cdiv class=\"SimplePara\"\u003en (%) or Median (IQR)\u003c/div\u003e\u003c/th\u003e\u003c/tr\u003e\u003ctr\u003e\u003cth align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cdiv class=\"SimplePara\"\u003eDemographics\u003c/div\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cdiv class=\"SimplePara\"\u003eAge at admission, years, \u003cspan type=\"Italic\" class=\"Italic\" name=\"Emphasis\"\u003emedian (IQR)\u003c/span\u003e\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cdiv class=\"SimplePara\"\u003e8 (\u003cspan additionalcitationids=\"CR2 CR3 CR4 CR5 CR6 CR7 CR8 CR9 CR10\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e)\u003c/div\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cdiv class=\"SimplePara\"\u003eFemale\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cdiv class=\"SimplePara\"\u003e22 (61%)\u003c/div\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cdiv class=\"SimplePara\"\u003ePreviously healthy before infection\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cdiv class=\"SimplePara\"\u003e37 (100%)\u003c/div\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003ePrimary infectious focus\u003c/span\u003e\u003c/div\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cdiv class=\"SimplePara\"\u003eEar-Nose-Throat-Infection\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cdiv class=\"SimplePara\"\u003e27 (73%)\u003c/div\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cdiv class=\"SimplePara\"\u003eSoft-Tissue-Infection (incl. cellulitis and phlegmone)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cdiv class=\"SimplePara\"\u003e10 (27%)\u003c/div\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003ePrimary infectious complication leading to PICU admission\u003c/span\u003e\u003c/div\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cdiv class=\"SimplePara\"\u003eIntracranial abscess / bacterial meningitis\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cdiv class=\"SimplePara\"\u003e17 (43%)\u003c/div\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cdiv class=\"SimplePara\"\u003eRetro-orbital abscess\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cdiv class=\"SimplePara\"\u003e10 (27%)\u003c/div\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cdiv class=\"SimplePara\"\u003eSeptic shock (incl. toxic shock syndrome)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cdiv class=\"SimplePara\"\u003e5 (14%)\u003c/div\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cdiv class=\"SimplePara\"\u003eOsteomyelitis\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cdiv class=\"SimplePara\"\u003e4 (11%)\u003c/div\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cdiv class=\"SimplePara\"\u003eNecrotizing fasciitis\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cdiv class=\"SimplePara\"\u003e1 (5%)\u003c/div\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003ePathogens identified\u003c/span\u003e\u003c/div\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Italic\" class=\"Italic\" name=\"Emphasis\"\u003eStreptococcus\u003c/span\u003e\u0026nbsp;spp.\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cdiv class=\"SimplePara\"\u003e18 (49%)\u003c/div\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Italic\" class=\"Italic\" name=\"Emphasis\"\u003eStreptococcus pyogens\u003c/span\u003e\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cdiv class=\"SimplePara\"\u003e13 (35%)\u003c/div\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Italic\" class=\"Italic\" name=\"Emphasis\"\u003eStreptococcus pneumoniae\u003c/span\u003e\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cdiv class=\"SimplePara\"\u003e1 (3%)\u003c/div\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Italic\" class=\"Italic\" name=\"Emphasis\"\u003eStreptococcus intermedius\u003c/span\u003e\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cdiv class=\"SimplePara\"\u003e4 (11%)\u003c/div\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Italic\" class=\"Italic\" name=\"Emphasis\"\u003eStaphylococcus aureus\u003c/span\u003e\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cdiv class=\"SimplePara\"\u003e9 (24%)\u003c/div\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cdiv class=\"SimplePara\"\u003eOther bacteria*\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cdiv class=\"SimplePara\"\u003e10 (27%)\u003c/div\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e\u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003ePICU course\u003c/span\u003e\u003c/div\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cdiv class=\"SimplePara\"\u003eAntimicrobial therapy\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cdiv class=\"SimplePara\"\u003e35 (95%)\u003c/div\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cdiv class=\"SimplePara\"\u003eSurgical source control (drainage/debridement)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cdiv class=\"SimplePara\"\u003e32 (87%)\u003c/div\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cdiv class=\"SimplePara\"\u003eLength of PICU stay, days, \u003cspan type=\"Italic\" class=\"Italic\" name=\"Emphasis\"\u003emedian (IQR)\u003c/span\u003e\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cdiv class=\"SimplePara\"\u003e4 (\u003cspan additionalcitationids=\"CR3 CR4\" citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e)\u003c/div\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cdiv class=\"SimplePara\"\u003eMechanical ventilation\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cdiv class=\"SimplePara\"\u003e30 (81%)\u003c/div\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cdiv class=\"SimplePara\"\u003eLength of mechanical ventilation, days, \u003cspan type=\"Italic\" class=\"Italic\" name=\"Emphasis\"\u003emedian (IQR)\u003c/span\u003e\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cdiv class=\"SimplePara\"\u003e1 (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e)\u003c/div\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cdiv class=\"SimplePara\"\u003eVasoactive support\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cdiv class=\"SimplePara\"\u003e14 (38%)\u003c/div\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cdiv class=\"SimplePara\"\u003eDuration of vasoactive support, days, \u003cspan type=\"Italic\" class=\"Italic\" name=\"Emphasis\"\u003emedian (IQR)\u003c/span\u003e\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cdiv class=\"SimplePara\"\u003e1 (1\u0026ndash;3.5)\u003c/div\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cdiv class=\"SimplePara\"\u003eSedative medication\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cdiv class=\"SimplePara\"\u003e30 (81%)\u003c/div\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cdiv class=\"SimplePara\"\u003eSedation duration, days, \u003cspan type=\"Italic\" class=\"Italic\" name=\"Emphasis\"\u003emedian (IQR)\u003c/span\u003e\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cdiv class=\"SimplePara\"\u003e2 (\u003cspan additionalcitationids=\"CR2 CR3\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e)\u003c/div\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cdiv class=\"SimplePara\"\u003eDelirium\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cdiv class=\"SimplePara\"\u003e12 (32%)\u003c/div\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eOverall Outcome\u003c/span\u003e\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cdiv class=\"SimplePara\"\u003ePCPC change (from admission to discharge), \u003cspan type=\"Italic\" class=\"Italic\" name=\"Emphasis\"\u003emedian (IQR)\u003c/span\u003e\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cdiv class=\"SimplePara\"\u003e1 (0\u0026ndash;1)\u003c/div\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cdiv class=\"SimplePara\"\u003ePCPC before admission, \u003cspan type=\"Italic\" class=\"Italic\" name=\"Emphasis\"\u003emedian (IQR)\u003c/span\u003e\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cdiv class=\"SimplePara\"\u003e1 (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e)\u003c/div\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cdiv class=\"SimplePara\"\u003ePCPC after admission, \u003cspan type=\"Italic\" class=\"Italic\" name=\"Emphasis\"\u003emedian (IQR)\u003c/span\u003e\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cdiv class=\"SimplePara\"\u003e2 (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e)\u003c/div\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cdiv class=\"SimplePara\"\u003eMortality\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cdiv class=\"SimplePara\"\u003e0 (0%)\u003c/div\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cdiv class=\"SimplePara\"\u003eSequelae\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cdiv class=\"SimplePara\"\u003e25 (68%)\u003c/div\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cdiv class=\"SimplePara\"\u003eTime to diagnosis of sequelae, month, \u003cspan type=\"Italic\" class=\"Italic\" name=\"Emphasis\"\u003emedian (IQR)\u003c/span\u003e\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cdiv class=\"SimplePara\"\u003e5 (\u003cspan additionalcitationids=\"CR2\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e)\u003c/div\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eSpecific sequelae\u003c/span\u003e\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cdiv class=\"SimplePara\"\u003eSeizures (newly diagnosed after discharge)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cdiv class=\"SimplePara\"\u003e8 (22%)\u003c/div\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cdiv class=\"SimplePara\"\u003eNewly diagnosed migraine (needing medication)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cdiv class=\"SimplePara\"\u003e10 (27%)\u003c/div\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cdiv class=\"SimplePara\"\u003eMotor deficits (physiotherapeutic assessment, necessity of aids)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cdiv class=\"SimplePara\"\u003e10 (27%)\u003c/div\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cdiv class=\"SimplePara\"\u003eVisual impairment (ophthalmologically confirmed)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cdiv class=\"SimplePara\"\u003e8 (22%)\u003c/div\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cdiv class=\"SimplePara\"\u003eHearing impairment (decrease in audiogram)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cdiv class=\"SimplePara\"\u003e10 (27%)\u003c/div\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cdiv class=\"SimplePara\"\u003eDevelopmental regression or lack of developmental progress (psychological and pediatric assessment using among others \u003cspan type=\"Italic\" class=\"Italic\" name=\"Emphasis\"\u003eBayley Scales of Infant Development testing and WISC-V)\u003c/span\u003e\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cdiv class=\"SimplePara\"\u003e10 (27%)\u003c/div\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cdiv class=\"SimplePara\"\u003eAttention deficits (needing therapy/medication, school difficulties\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cdiv class=\"SimplePara\"\u003e8 (22%)\u003c/div\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cdiv class=\"SimplePara\"\u003eDepression, anxiety (psychological evaluated and need for therapy - previously screened using ILK, BAI-Y, TEX-Q)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cdiv class=\"SimplePara\"\u003e9 (24%)\u003c/div\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eTherapies\u003c/span\u003e\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cdiv class=\"SimplePara\"\u003eInpatient rehabilitation\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cdiv class=\"SimplePara\"\u003e17 (46%)\u003c/div\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cdiv class=\"SimplePara\"\u003eReferral to psychologist\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cdiv class=\"SimplePara\"\u003e12 (32%)\u003c/div\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cdiv class=\"SimplePara\"\u003eReferral to physiotherapy\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cdiv class=\"SimplePara\"\u003e14 (38%)\u003c/div\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cdiv class=\"SimplePara\"\u003eReferral to occupational therapy\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cdiv class=\"SimplePara\"\u003e18 (49%)\u003c/div\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cdiv class=\"SimplePara\"\u003eReferral to speech therapy\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cdiv class=\"SimplePara\"\u003e8 (22%)\u003c/div\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cdiv class=\"SimplePara\"\u003eMedication after discharge\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cdiv class=\"SimplePara\"\u003e13 (35%)\u003c/div\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cdiv class=\"SimplePara\"\u003eOthers**\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cdiv class=\"SimplePara\"\u003e7 (19%)\u003c/div\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eDifficulties within coding resulting funding challenges\u003c/span\u003e\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cdiv class=\"SimplePara\"\u003eAll therapies\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cdiv class=\"SimplePara\"\u003e22 (59%)\u003c/div\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cdiv class=\"SimplePara\"\u003eInpatient rehabilitation\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cdiv class=\"SimplePara\"\u003e13 / 17 (45%)\u003c/div\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eFollow-up attendence and continuity***\u003c/span\u003e\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cdiv class=\"SimplePara\"\u003eAttended Post-PICU Visit 1 (\u0026asymp;\u0026thinsp;4 weeks)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cdiv class=\"SimplePara\"\u003e30 (81%)\u003c/div\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cdiv class=\"SimplePara\"\u003eAttended Post-PICU Visit 2 (\u0026asymp;\u0026thinsp;3 months)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cdiv class=\"SimplePara\"\u003e25 (68%)\u003c/div\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cdiv class=\"SimplePara\"\u003eAttended Post-PICU Visit 3 (\u0026asymp;\u0026thinsp;6 months)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cdiv class=\"SimplePara\"\u003e23 (62%)\u003c/div\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cdiv class=\"SimplePara\"\u003eAttended Post-PICU Visit 4 (\u0026asymp;\u0026thinsp;12 months)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cdiv class=\"SimplePara\"\u003e23 (62%)\u003c/div\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cdiv class=\"SimplePara\"\u003eAdditional visits (between standard visits)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cdiv class=\"SimplePara\"\u003e11 (30%)\u003c/div\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003cp\u003e*Others included atypical mycobacteria (n = 2), Klebsiella spp. (n = 1), mycoplasma (n = 1), unknown pathogen (n = 6); **Others: plastic issues (4), partial limp loss (2), chronic pain (1), Cochlea implant (1); *** Reasons for not attendance: still in inpatient rehabilitation (3), no further need for follow-up (4), family moved away (3), incompliance/missed appointments (4); Abbreviation: BAI-Y = Beck Anxiety Inventory for Youth; BSCI-Y = Body Self-Perception Inventory for Youth; ILK = Quality of Life in Children and Adolescents; PCPC = Pediatric Cerebral Performance Category Scale; PICU = Paediatric Intensive Care Unit; Streptococcus spp. = Streptococcus species; TEX-Q = Therapy Expectation Questionnaire; WISC-V = Wechsler Intelligence Scale for Children-V\u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eOverview of the standardized multidomain follow-up test battery\u003c/span\u003e used within the structured post-PICU follow-up program. Assessments were age-adapted and administered by trained pediatric neurologists, psychologists, and physiotherapists.\u003c/div\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cdiv class=\"SimplePara\"\u003eDomain\u003c/div\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cdiv class=\"SimplePara\"\u003eAssessment Tools / Methods\u003c/div\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cdiv class=\"SimplePara\"\u003ePurpose / Outcome Measured\u003c/div\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cdiv class=\"SimplePara\"\u003eMonths After Discharge\u003c/div\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003ePhysical /\u003c/span\u003e\u003c/div\u003e\u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eSomatic Function\u003c/span\u003e\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cdiv class=\"SimplePara\"\u003eComprehensive pediatric examination with neuro-pediatric focus; as well as physiotherapeutic assessment\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cdiv class=\"SimplePara\"\u003eMotor deficits, muscle tone, coordination, residual neurological impairment, pain, developmental state\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cdiv class=\"SimplePara\"\u003e1, 3, 6, 12\u003c/div\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eNeurocognitive Development\u003c/span\u003e\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Italic\" class=\"Italic\" name=\"Emphasis\"\u003eBayley Scales of Infant and Toddler Development\u003c/span\u003e (for \u0026lt;\u0026thinsp;3 years); \u003cspan type=\"Italic\" class=\"Italic\" name=\"Emphasis\"\u003eWechsler Intelligence Scale for Children \u0026ndash; V\u003c/span\u003e\u0026nbsp;(WISC-V, for \u0026ge;\u0026thinsp;6 years)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cdiv class=\"SimplePara\"\u003eGlobal and domain-specific cognitive performance; developmental progress or regression\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cdiv class=\"SimplePara\"\u003e3, 6, 12\u003c/div\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003ePsychological /\u003c/span\u003e\u003c/div\u003e\u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eEmotional Function\u003c/span\u003e\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Italic\" class=\"Italic\" name=\"Emphasis\"\u003eBeck Anxiety Inventory for Youth\u003c/span\u003e\u0026nbsp;(BAI-Y);\u0026nbsp;\u003cspan type=\"Italic\" class=\"Italic\" name=\"Emphasis\"\u003eInventory for the Assessment of Quality of Life in Children and Adolescents\u003c/span\u003e\u0026nbsp;(ILK)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cdiv class=\"SimplePara\"\u003eAnxiety symptoms, depression, health-related quality of life\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cdiv class=\"SimplePara\"\u003e3, 6, 12\u003c/div\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eBody Image /\u003c/span\u003e\u003c/div\u003e\u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eSelf-Perception\u003c/span\u003e\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Italic\" class=\"Italic\" name=\"Emphasis\"\u003eBody Self-Perception Inventory for Youth\u003c/span\u003e\u0026nbsp;(BSCI-Y)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cdiv class=\"SimplePara\"\u003eSelf-esteem, perception of physical changes after illness\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cdiv class=\"SimplePara\"\u003e6, 12\u003c/div\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eTherapy Motivation / Expectation\u003c/span\u003e\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Italic\" class=\"Italic\" name=\"Emphasis\"\u003eTherapy Expectation Questionnaire\u003c/span\u003e\u0026nbsp;(TEX-Q)\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cdiv class=\"SimplePara\"\u003ePatient and family expectations and satisfaction regarding rehabilitation and follow-up care\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cdiv class=\"SimplePara\"\u003e3, 12\u003c/div\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003eFamily /\u003c/span\u003e\u003c/div\u003e\u003cdiv class=\"SimplePara\"\u003e\u003cspan type=\"Bold\" class=\"Bold\" name=\"Emphasis\"\u003ePsychosocial Impact\u003c/span\u003e\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cdiv class=\"SimplePara\"\u003eSemi-structured family interviews and psychologist evaluation\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cdiv class=\"SimplePara\"\u003eFamily functioning, parental stress, PICS-F screening\u003c/div\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cdiv class=\"SimplePara\"\u003e6, 12\u003c/div\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003cbr/\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"University of Duisburg-Essen","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Invasive streptococcal infections, pediatric post-intensive care syndrome (PICS-p), post-intensive care syndrome family (PICS-F), neurocognitive outcome, multidisciplinary care","lastPublishedDoi":"10.21203/rs.3.rs-8155821/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8155821/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cb\u003eObjective\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThis study aimed to evaluate physical, cognitive, and psychosocial outcomes in previously healthy children admitted to the Pediatric Intensive Care Unit (PICU) with severe complications arising from initially common community-acquired infections, and to describe the first-year experience of a structured post-intensive care follow-up program at a tertiary care hospital in Germany. Currently Germany lacks standardized follow-up structures for PICU survivors, despite growing recognition of long-term morbidity.\u003c/p\u003e\u003cp\u003e\u003cb\u003eDesign:\u003c/b\u003e\u003c/p\u003e\u003cp\u003eClinical and follow-up data were obtained retrospectively from in- and outpatient medical records of all PICU patients meeting inclusion criteria during the study period. Demographic, clinical, and follow-up data were extracted anonymously. Multidomain outcomes were assessed at 4 weeks, 3, 6, and 12 months after discharge, including physical, neurocognitive, and psychosocial parameters.\u003c/p\u003e\u003cp\u003e\u003cb\u003eSetting:\u003c/b\u003e\u003c/p\u003e\u003cp\u003eTertiary care University center in Germany.\u003c/p\u003e\u003cp\u003e\u003cb\u003ePatients:\u003c/b\u003e\u003c/p\u003e\u003cp\u003eAll previously healthy children (n\u0026thinsp;=\u0026thinsp;37, age\u0026thinsp;\u0026gt;\u0026thinsp;28 days and \u0026lt;\u0026thinsp;18 years) admitted to the PICU in 2023 due to severe infectious complications, including intracranial abscess or meningitis (43%), orbital abscesses (27%), septic shock (14%), osteomyelitis (11%), and necrotizing fasciitis (5%).\u003c/p\u003e\u003cp\u003e\u003cb\u003eInterventions:\u003c/b\u003e\u003c/p\u003e\u003cp\u003eNone.\u003c/p\u003e\u003cp\u003e\u003cb\u003eMeasurements and Main Results:\u003c/b\u003e\u003c/p\u003e\u003cp\u003eDespite appropriate acute management during the PICU stay, 25 children (68%) developed prolonged neurological, somatic, or psychosocial impairments, including motor deficits, neurocognitive dysfunction, and anxiety. Many sequelae emerged around 5 months after discharge. The heterogeneous recovery trajectories emphasize the clinical relevance of Pediatric Post-Intensive Care Syndrome (PICS-p).\u003c/p\u003e\u003cp\u003e\u003cb\u003eConclusions\u003c/b\u003e\u003c/p\u003e\u003cp\u003eOur findings highlight the need for multidisciplinary post-PICU follow-up, particularly for previously healthy children. Early recognition and targeted interventions may reduce long-term morbidity and improve quality of life for affected children and their families.\u003c/p\u003e","manuscriptTitle":"Severe bacterial infections requiring PICU admission in previously healthy children – Insights from a structured pediatric intensive care follow-up program","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-11-20 08:20:40","doi":"10.21203/rs.3.rs-8155821/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"413e5391-440b-4df2-95c7-d4ec05c91123","owner":[],"postedDate":"November 20th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":58261168,"name":"Pediatrics"}],"tags":[],"updatedAt":"2025-11-20T08:20:40+00:00","versionOfRecord":[],"versionCreatedAt":"2025-11-20 08:20:40","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8155821","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8155821","identity":"rs-8155821","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}