The finding that post-traumatic stress disorder is relatively common in school-age children who have extended stays in intensive care units after cardiac surgery should remind physicians about the psychiatric vulnerability of young patients with long or involved hospitalizations, according to an article in the April issue of the Journal of Pediatrics.

The current study, led by Dana Connolly, PhD, and Michael Artman, MD, is the first of its kind to examine the psychosocial responses of school-age children to cardiac surgery. A total of 43 families participated in the study, which involved 2 academic medical centers. The children, who ranged from 5 to 12 years of age, underwent cardiac surgery for congenital heart defects. Each child was evaluated pre- and post-operatively for the disorder using tools that determine anxiety disorders, nonverbal reasoning, and temperament. None of the children showed signs of post-traumatic stress disorder before surgery.

During the post-surgical assessment, researchers found that characteristics of the disorder increased in children who stayed in the intensive care unit for more than 48 hours. After hospitalization, 5 (12%) of the children met diagnostic criteria for the disorder, and 5 (12%) exhibited some of characteristics including disorganized behavior, nightmares, sleep disorders, and concentration problems. Children exhibiting signs of post-traumatic stress disorder were referred to pediatric psychiatrists for further evaluation and care.

"It's important for parents to look for behavioral changes such as bed wetting, night screams, clinging, and concentration problems once the child comes home from surgery," said Connolly. Despite efforts to minimize the stress and emotional trauma that can be associated with heart surgery for children and their families, the study showed, for the first time, a clinically significant risk of post-operative post-traumatic stress disorder in pediatric patients.

According to Artman, "Even though this was a relatively small sample, it is impressive that roughly 1 in 10 children develop full blown post-traumatic stress disorder after undergoing heart surgery. The only factor we found that seemed to correlate with post-traumatic stress disorder was a stay of more than 48 hours in the intensive care unit, which is really not very long. Presently, we don't know what factors in the intensive care unit might be contributing, but our new findings clearly demonstrate the need for future research."