Parental Stress in the Pediatric Intensive Care Unit and Its Association with Clinical Outcomes: A Prospective Observational Study

BACKGROUND: Children, who represent the emotional center of parents and the future of the nation, when hospitalized in the pediatric intensive care unit (PICU), place caregivers under substantial psychological strain due to disruption of family life and persistent uncertainty during critical illness. OBJECTIVES: To assess parental stress during PICU admission using length of stay as a proxy indicator and to examine its association with selected clinical outcomes among critically ill children. MATERIALS AND METHODS: This prospective observational study was conducted in the PICU of a tertiary care teaching hospital over 2 years. All children aged 0-16 years admitted to the PICU during the study period were included. Demographic details, admission characteristics, primary diagnoses, duration of PICU stay and treatment outcomes were recorded using a structured pro forma. Length of PICU stay was categorized into low (1-2 days), moderate (3-5 days) and high (>5 days) stress proxy groups. Data were analyzed using descriptive statistics and Chi-square test, with a P < 0.05 considered statistically significant. RESULTS: A total of 614 children were included. Infants aged 1-12 months constituted the largest proportion of admissions (37.8%) and males predominated (58.6%). Most admissions occurred through the emergency department (61.9%), with nearly half being referred cases (47.6%). Infectious and respiratory illnesses were the most common indications for PICU admission. Moderate stress proxy duration (3-5 days) was observed in 41.5% of admissions, while 20.4% required prolonged PICU stay (>5 days). A statistically significant association was found between stress proxy categories and treatment outcomes (χ2 = 11.84; P = 0.019), with prolonged PICU stay associated with higher rates of discharge against medical advice and less favorable disposition patterns. CONCLUSION: Parental stress exposure, reflected by prolonged PICU stay, shows a significant association with clinical outcomes in critically ill children. These findings highlight the importance of incorporating psychosocial considerations and family-centered approaches into routine pediatric intensive care practice.