The study, published in the journal Australian Critical Care, discovered that elevated posttraumatic stress symptoms were present in 24% of children 12 months after hospital discharge, most likely in children treated with midazolam.
Midazolam is used to sedate children who require life-saving treatments such as intubation, but the long-term effects of this medication have not been studied in children previously.
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- Longitudinal study confirms a link between midazolam and elevated posttraumatic stress symptoms (PTSS) in some children.
- Children exposed to midazolam were almost four times more likely to have elevated PTSS.
- PTSS can included nightmares, difficulty sleeping, reliving the event in thought and play, angry outbursts and ongoing fear or sadness.
- Study raises awareness of potential adverse effects and need for early interventions for at-risk children.
The first longitudinal study, a collaboration between QUT, UQ and Children’s Health Queensland and led by Professor Debbie Long, identified a link between midazolam and posttraumatic stress symptoms in children.
She said that while this drug was already linked to PTSD in adults, this was the first study to find a link in children as young as two.
Between 2008 and 2011, 265 Queensland hospitalised children aged 2 to 16 were studied. Parents completed behaviour surveys every one, three, six, and twelve months.
The study found that children with severe PTSS after intensive care were 3.63 times more likely to have been exposed to midazolam.
While other drugs with neuroprotective benefits have become available in recent years, midazolam was still widely used, and the study served to raise awareness of its potential adverse effects and the need for early intervention, she said.
Her team had demonstrated dexmedetomidine for long-term sedation up to 14 days as an amnesic-free alternative to midazolam, but it would not fully replace it.
“One of the benefits of dexmedetomidine is that we can reach the desired levels of sedation quickly and safely and have more awake sedation, allowing children to be calm and comfortable,” Associate Professor Long said.
“But there are some illnesses and injuries, such as seizures, for which midazolam is still considered the first line therapy so it is unlikely that the drug will be completely removed from our treatment armoury.”
Every year, over 10,000 children are admitted to paediatric intensive care units in Australia and New Zealand due to trauma or critical illness.
Associate Professor Long said most children admitted to intensive care were under five, and half were under two.
“It was thought that giving a child midazolam would help them forget being in intensive care. But unfortunately, we think it distorts their memory making process,” she said.
“It’s possible they construct nonfactual memories and that, combined with drug withdrawal-related delirium, could lead to posttraumatic stress in the acute recovery phase.
“We’re starting to wonder if early posttraumatic stress is a gateway disorder to anxiety and depression even if it resolves, because health conditions like these are doubling as more children survive intensive care.
“If symptoms are not identified and managed early, the ripple effect could be life-long—affecting relationships at home, school or when getting a job in later years.”
Associate Professor Long stated that the study’s findings indicated that symptoms were significant in the first month following care but could persist for ten to twelve months before resolving, and that some children continued to have elevated symptoms at 12 months.
“Our concern is that families with children who experience posttraumatic stress won’t engage in ongoing care because they’re too traumatised,” she said.
“Identification of the early distress allows medical professionals to engage families sooner and monitor children more closely.”
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While the study examined the relationship between intensive care treatment factors and posttraumatic stress symptoms in children, Associate Professor Long noted that non-treatment variables such as acutely distressed parents during admission and pre-existing internalizing child behaviours also predicted continued distress following hospital discharge.
Associate Professor Long will soon co-lead an interventional study using the findings from the study to examine psychosocial support for parents and children, as well as ways to normalise the hospital treatment process in order to reduce the incidence of posttraumatic stress.