Survivors of septic shock caused by Neisseria meningitidis in childhood: psychosocial outcomes in young adulthood.

OBJECTIVE: To investigate long-term psychosocial outcomes in young adults who survived septic shock caused by Neisseria meningitidis (meningococcal septic shock) during childhood. DESIGN: A cross-sectional study. SETTING: The psychological investigation took place in the department of Child and Adolescent Psychiatry of the Erasmus MC-Sophia Children's Hospital. PATIENTS: All consecutive surviving patients with meningococcal septic shock requiring intensive care treatment at the pediatric intensive care unit between 1988 and 2001. INTERVENTION: To explore biographical characteristics (such as living conditions, educational, occupational, and marital status) and illness-related physical or social consequences a structured interview was used. To assess intellectual functioning the Groninger Intelligence Test 2 was used and to assess behavioral/emotional problems, the Adult Self-Report was used. MEASUREMENTS AND MAIN RESULTS: Fifty-eight of 83 eligible septic shock survivors were evaluated (response rate: 70%). The patients were 16-31 yrs old at time of follow-up (median age: 21 yrs old). These patients had had meningococcal septic shock before 18 yrs of age. Median follow-up interval was 13 yrs, with a range of 4 to 16 yrs. For the vast majority of meningococcal septic shock patients, outcomes on biographical characteristics, intellectual functioning, and levels of behavioral/emotional problems were comparable to those of reference groups. A minority (5% to 20%) still report illness-related physical or social consequences, behavioral and emotional problems, and lower intellectual functioning. CONCLUSIONS: Despite favorable outcomes for the majority of meningococcal septic shock patients in the long term, an important minority (5% to 20%) still struggles with ongoing problems as to behavioral/emotional problems, intellectual functioning, biographical characteristics, and illness-related physical or social consequences.

Surviving meningococcal septic shock in childhood: long-term overall outcome and the effect on health-related quality of life.

INTRODUCTION: The purpose of this study was to evaluate associations between long-term physical and psychological outcome variables in patients who survived meningococcal septic shock (MSS) in childhood. METHODS: The study population was made up of all MSS patients requiring intensive care treatment between 1988 and 2001. RESULTS: A total of 120 patients visited the follow-up clinic (age at paediatric intensive care unit (PICU) admission 3.1 years; follow-up interval 9.8 years; age at follow-up 14.5 years (all medians)). Four major outcomes were considered: 1) major physical sequelae (defined as major scars and/or orthopaedic sequelae) (29/120), 2) mild neurological impairments (39/120), 3) problem behaviour (defined as a total score above the 90th percentile of the reference groups on questionnaires to screen for psychopathology) (16/114) and 4) total intelligence quotient < 85 (18/115). No differences were found between patients with major physical sequelae and patients without major physical sequelae as to the presence of problem behaviour or total IQ < 85. Also, no differences were found between patients with mild neurological impairments and patients without as to the presence of problem behaviour or total IQ < 85. Finally, no differences were found between patients with major physical sequelae and patients without as to the presence of mild neurological sequelae. Less favourable scores on behavioural and emotional problems were significantly associated with poorer health-related quality of life (HR-QoL). HR-QoL scores were to a lesser amount predicted by severity of illness at time of PICU admission or by adverse physical outcome. CONCLUSIONS: Long-term adverse physical and psychological outcomes in survivors of MSS did not seem to be associated. Poorer HR-QoL was mainly predicted by problem behaviour.

Long-term health status in childhood survivors of meningococcal septic shock.

OBJECTIVE: To assess long-term health status in patients who survived meningococcal septic shock in childhood. DESIGN: Medical and psychological follow-up of a cross-sectional cohort. SETTING: Pediatric intensive care unit (PICU) of a tertiary care university hospital. PARTICIPANTS: All consecutive patients with septic shock and purpura who required intensive care between 1988 and 2001. Intervention Patients and their parents were invited to our follow-up clinic 4 to 16 years after PICU discharge. OUTCOME MEASURES: Health status was assessed with a standard medical interview, physical examination, renal function test, and the Health Utilities Index Mark 2 (HUI2) and 3 (HUI3). RESULTS: One hundred twenty patients (response rate 71%) participated in the follow-up (median age at PICU admission, 3.1 years; median follow-up interval, 9.8 years; median age at follow-up, 14.5 years). Thirty-five percent of patients had 1 or more of the following neurological impairments: severe mental retardation with epilepsy (3%), hearing loss (2%), chronic headache (28%), and focal neurological signs (6%), like paresis of 1 arm. One of the 16 patients with septic shock-associated acute renal failure at PICU admission showed signs of mild chronic renal failure (glomerular filtration rate, 62 mL/min/1.73 m(2); proteinuria; and hypertension). Scores were significantly lower on nearly all HUI2 and HUI3 attributes compared with Dutch population data, indicating poorer health in these patients. CONCLUSIONS: In patients who survived meningococcal septic shock in childhood, one-third showed long-term neurological impairments, ranging from mild to severe and irreversible. Patients reported poorer general health as measured by HUI2 and HUI3.

Self-esteem in children and adolescents after septic shock caused by Neisseria meningitidis: scars do matter.

PURPOSE: To investigate self-esteem and its relation to scars, amputations, and orthopedic sequelae in children and adolescents long term after meningococcal septic shock (MSS) caused by Neisseria meningitidis. METHODS: The Dutch versions of the Self-Perception Profile for Children (SPP-C; 8-11 years) and the Self-Perception Profile for Adolescents (SPP-A; 12-17 years) were used to assess self-esteem. The Patient and Scar Assessment Scale (PSAS) was used to evaluate scar severity. RESULTS: MSS boys aged 8-11 years achieved higher, more favorable scores on self-esteem, whereas same-aged MSS girls reported comparable levels of self-esteem compared with the respectively same-aged reference boys and girls. MSS boys and girls aged 12-17 years obtained unfavorable scores on self-esteem compared with respectively same-aged reference boys and girls. Overall gender did not have an effect on self-esteem. Severity of illness, age at time of illness, and age at time of follow-up were not significant predictors of self-esteem. MSS adolescents with scars reported lower global self-worth than MSS adolescents without scars. The worse MSS children evaluated their scars, the worse their outcomes on social acceptance. The worse MSS adolescents evaluated their scars, the worse their outcomes on close friendship, but the better their outcomes on social acceptance and behavioral conduct. CONCLUSION: In this cross-sectional study, favorable outcomes for self-esteem were found in MSS children, whereas MSS adolescents reported lower self-esteem compared with reference adolescents. Adolescents with scars reported lower global self-worth than MSS adolescents without scars.

Long-term health-related quality of life in survivors of meningococcal septic shock in childhood and their parents.

OBJECTIVE: To assess long-term health-related quality of life (HR-QoL) in patients who survived meningococcal septic shock in childhood, and their parents. PATIENTS AND METHODS: All consecutive patients with meningococcal septic shock requiring intensive care treatment between 1988 and 2001, and their parents. HR-QoL was assessed by the Child Health Questionnaire and the SF-36. Scores were compared with reference data of Dutch general population samples. Lower scores indicated poorer HR-QoL, higher scores more favourable HR-QoL. RESULTS: One hundred and forty-five patients (response rate 82%) agreed to participate (age PICU admission 3.5 years; follow-up interval 10 years; age follow-up 14.6 years (all medians)). In patients, regardless of age and of patient- versus parent-report, significantly lower scores were found mainly on physical (physical functioning, general health perception) domains and/or physical summary score. In patients <18 years, according to parent-reports, significantly lower scores were also found on psychosocial HR-QoL domains, whereas in patients > or =12 years, according to patients themselves, significantly higher scores were found on psychosocial domains. As to parents themselves, we found significantly higher scores on the majority of HR-QoL scales (both physical and psychosocial). CONCLUSIONS: In patients who survived meningococcal septic shock in childhood significantly lower HR-QoL scores were found on the physical domains. This could indicate that the patient's disease episode and present health status had a negative impact on their present physical HR-QoL. Overall long-term HR-QoL in parents was significantly higher.