Advancement in pediatric critical care medicine (PCCM) has reduced childhood mortality. As such, focus has been diverted to investigate the development of new morbidity following discharge from the Pediatric Intensive Care Unit (PICU) (1). Post-Intensive Care Syndrome in Pediatrics (PICS-p) is a framework that categorizes the decline in functioning or new onset impairments in physical, social, psychological and cognitive health domains following admission in the Pediatric Intensive Care Unit (PICU) (2). Childhood being a significant period of maturation and growth and that impact of survival can last days to decades (3).

Understanding the risk factors associated with PICS-p is crucial for planning effective management strategies for improving long-term outcomes in children. (4). Many studies have highlighted several risk factors of PICS-p, emphasizing the significance of clinical and demographic factors. For instance, the important one among these at the time of admission to the PICU was the severity of illness (5). Furthermore, length of stay in the PICU is a key risk factor for post-PICU syndrome, and studies reveal that longer PICU stays correlates with high rates of cognitive and psychological problems post-PICU hospitalization (6, 7). Approximately one in five children are diagnosed with PICS-p, defined by cognitive impairment when they spend four or more days in the PICU (6, 8).

The post-ICU pediatric population is likely to develop PICS-p, study showed that children with pre-existing neurological and neuromuscular conditions who rely on different levels of baseline-dependent care are more prone to develop PICS-p (9). Prolonged mechanical ventilation has also been implicated in higher risk (10). However, these results are not conclusive and may differ from study to study (6, 11). Long periods of bed rest during critical illness are associated with longer-term physical limitations post-discharge, which highlights the necessity of maintaining mobility and rehabilitation at the time of the ICU stay (12).

The psychological factors that contribute to PICS-p are important as well. The life of the child, as well as their family, can be greatly influenced by recovery outcomes (13, 14). Cognitive impairment is another critical driver of PICS-p, with reports suggesting attention, memory, and executive function problems among survivors (4, 15). Furthermore, benzodiazepine use as a common sedative and delirium risk factor has been identified as an additional contributor to the presence of both delirium and subsequently PICS in children, and in the PICU, the administration of narcotics and delusional memories has also been implicated as delaying recovery (16).

Understanding PICS-p risk factors will help in early interventions, enhanced patient outcomes, and the efficient use of healthcare resources. This review is intended to collect evidence that will be useful in informing clinical practice and preventive efforts on preventive work for at-risk children.