Risk of Neuropsychiatric Disorders After Pediatric Delirium in Children Under 12: A Cohort Study

OBJECTIVE: Delirium is known to be related to neuropsychiatric comorbidities as long-term consequences in adult patients. However, the risk of major neuropsychiatric disorders after pediatric delirium remains largely unexplored. METHODS: We analyzed de-identified electronic health records (2013 to 2023) from the TriNetX Research network, a network with more than 111 million patients. Patients under age 12 years with delirium and a control group without delirium were identified and matched by age, sex, race, ethnicity, and physical comorbidities at a one-to-four ratio. We applied Cox regression and Kaplan-Meier analysis to assess the risk of neuropsychiatric disorders. RESULTS: A total of 618 pediatric patients with delirium were included, demonstrating a 2.15-fold higher risk of neuropsychiatric disorders than controls without delirium (hazard ratio [HR] with 95% confidence interval [CI]: 2.15, 1.82-2.56). The 5-year freedom from these disorders was 68.5% (95% CI, 65.5-71.8) in the study cohort, whereas it was 49.8% (95% CI, 44.1-56.2) in the control cohort. Subgroup analysis showed that children aged 6 years or younger were more likely to be diagnosed with externalizing disorder, including substance use disorder (HR=4.34; 95% CI, 2.00-9.44; p<0.001), intellectual disability (HR=1.71; 95% CI, 1.27-2.30; p<0.001), and attention-deficit/hyperactivity disorder (HR=2.25; 95% CI, 1.16-4.34; p=0.02). CONCLUSION: Pediatric patients with delirium are at increased risk of major neuropsychiatric disorders compared to their control counterparts without delirium. Clinicians need to be aware of early symptoms and signs suggesting major neuropsychiatric disorders during the long-term follow-up period.