Children and parents are monitored for follow-up consultation hours after admission to the intensive care unit

Every year, about 300 children are resuscitated outside the hospital in the Netherlands

Every year, several dozen children with potential brain damage end up in the pediatric intensive care unit at Sophia Børnehospitalet. If they survive, they will be followed for years after their discharge by a unique follow-up consultation to see how they are doing.

This applies, among other things, to children who have had a cardiac arrest, which has meant that the brain has not received oxygen for a while, for example after an almost drowning or a heart rhythm disorder. But also for children with severe concussion, for example after a traffic accident.

During the consultation, which is unique in the Netherlands, pediatric neurologist Maayke Hunfeld, pediatric IC doctor Corinne Buysse and child psychologists look at how children feel, how they develop in school, how their friendships feel and how their parents feel. do. , siblings. Because they had a very hard time during the scary days in the intensive care unit, says Maayke Hunfeld.

The primary goal of the outpatient clinic is to provide good aftercare. So the kids and their parents know we are there for them. These children have literally been near death for a moment, and their parents have been horrified. The children themselves do not usually know much about it, but these events often cause psychological trauma to the parents. ‘

It’s hard to share those experiences with their friends. At Hunfeld’s consultation class, they can talk about what happened in that IC. ‘It is important that parents can process their trauma. If you feel better as a parent, you can also take better care of your children. ‘

Healthcare professionals working at the Pediatric ICU are also happy with the outpatient clinic. “Doctors and nurses take care of the child when it is critically ill. After discharge, they usually do not see the children again. We often take pictures of children, and when we teach IC nurses we ask: who do you want to know something about? Then we show a picture of ‘Karltje’ and tell how he feels. Then the ICU nurses know what they’re doing it for. ‘

‘Children themselves do not know much about it, but these events often cause psychological trauma for the parents’

Crucial moments
The children come to the follow-up outpatient clinic at different times after discharge from the hospital. After three months, after one year, after 2 years and, depending on their age at the time of admission, at their 5th, 8th, 12th and 17th year of life.

The ages are chosen consciously. “At 5 o’clock they go to 2nd grade, at 8 o’clock the brain begins to learn to plan, at 12 o’clock they go to high school and as a 17-year-old they go on to college,” Hunfeld explains. At the crucial times, a comprehensive review is conducted to see how the children are doing.

The follow-up consultation is unique in the world, says Hunfeld. ‘Other children’s hospitals in the world are looking at how we are doing here. For everyone wants to know: how does a child feel after an acute cardiac arrest, and after an acute brain injury? ‘

Hunfeld conducted PhD research in this, among other things on the basis of data from the follow-up outpatient clinic. What is life like for children who survived CPR, and can pediatricians determine what the future looks like shortly after cardiac arrest? Protocols for this are already available in adults. But much more research is needed in children to draw up guidelines for this, the conclusion reads.

‘We are now working on a national database to collect more data on children with cardiac arrest, as it is a rare condition. In general, we can now only state: if no damage can be seen on the MRI of the brain, then the child will usually be well. If there is a lot of damage, the prognosis is poor. But there are many MRIs where you can see some abnormalities, but you do not know what the consequences are. ‘

Although Hunfeld sees the most disturbing cases in the intensive care unit, she is not herself an overprotective mother. ‘I’m sober. I realize: what I see here in IC are the exceptions. I have always been careful with water. Fortunately, my youngest son now has a swimming diploma B. ‘

Her message to the outside world: if you find a child with cardiac arrest: CPR! Get that AED from the wall and start. ‘A significant number of children recover well after a cardiac arrest, and such an AED tells you exactly what to do.’

‘I sometimes hear people are afraid to revive a child, but do it! In the Netherlands, survival rates are better than in other countries due to our Citizens’ Network. People who can revive get a signal on their phone if someone gets a cardiac arrest somewhere. So resuscitation really makes sense. Also for children. ‘

Every year in the Netherlands, about 300 children are resuscitated outside the hospital, for example after an acute cardiac arrest, atrial fibrillation or an almost drowning. They are usually admitted unconscious to the pediatric intensive care unit.

More than half do not survive CPR. Some of them are legally brain dead, for others the brain damage that can be seen on an MRI and a brain video is so great that recovery is not considered possible.

About 45 percent survive CPR. 75 percent of them are well, these children can go through life independently. However, learning difficulties often arise over time. It needs to be investigated whether these learning problems can be remedied with special cognitive learning programs.

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