A new study from Penn Nursing suggests that certain sedatives used during critical illnesses in early childhood may have long-term effects on children’s neurocognitive development. Dr. Martha A. Q. Curley, RN, FAAN, Professor, Department of Family and Community Health, Ruth M. Colkett Endowed Chair in Pediatric Nursing, Children’s Hospital of Philadelphia. He co-led the study with R. Scott Watson, M.D., of Seattle Children’s Hospital.
This study JAMA network openfound that while most children who survived serious illnesses requiring sedation had IQ scores within the normal range, children treated with only a combination of opioids and benzodiazepines had lower subsequent neurocognitive test scores than children treated with the sedative dexmedetomidine.
Assessing long-term impacts
Seriously ill young children often require days or weeks of sedation to tolerate life-saving treatments such as mechanical ventilation. Although these drugs are necessary, concerns persist about their potential toxicity to the developing brain.
The RESTORE-Cognitive Study followed 256 children aged 8 years or younger at the time of hospitalization with acute respiratory failure. Researchers conducted comprehensive neurocognitive testing, including assessments of IQ, memory, and attention, three to eight years after the children were discharged from the pediatric intensive care unit (PICU).
Main findings
- general cognitive functions: The average estimated IQ of the study participants was 100.3, which is in line with the average for the general population.
- Sedation strategies are important: After adjusting for factors such as socioeconomic status and severity of the underlying illness, the adjusted mean IQ of children who received only opioids and benzodiazepines was about 4 points lower than children who received dexmedetomidine as part of their treatment.
- Vulnerability at high doses: This difference was even more pronounced in children who required the highest doses of benzodiazepines. In this group, patients treated with opioids and benzodiazepines alone had IQ scores nearly 8 points lower than those who also received dexmedetomidine.
- specific deficit: Beyond overall IQ, researchers observed lower-than-average scores across the group of survivors in areas such as nonverbal memory, visuospatial skills, and fine motor control.
Clinical impact
For a long time, there was no clear evidence about which sedatives were best for critically ill children on ventilators. Our study shows that choices made in the pediatric ICU can influence a child’s brain development years later. Specifically, adding dexmedetomidine to a treatment plan may be more protective of children’s long-term thinking and learning skills than using opioids or benzodiazepines alone. ”
Dr. Martha A. Q. Curley, RN, FAAN, Ruth M. Colkett Endowed Chair in Pediatric Nursing, Department of Family and Community Health, Children’s Hospital of Philadelphia
This study highlights the importance of long-term follow-up for PICU survivors to identify and support children who may be experiencing subtle but impactful neurocognitive challenges.
RESTORE-About cognitive research
This multicenter prospective cohort study was conducted as a follow-up to the Randomized Evaluation of Sedation Titration for Respiratory Failure (RESTORE) clinical trial, which was conducted in 31 PICUs across the United States. This research was supported by the National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health (NIH) through grant U01 HL086622 (MAQ Curley), which funded the initial RESTORE clinical trial, and R01 HD074757, which supported the long-term neurocognitive follow-up study (MAQ Curley, RS Watson).
Co-authors include Dr. Sue R. Beers and Dr. Cheryl Burns of the University of Pittsburgh School of Medicine. Lisa A. Asaro, MD, Min-Jung Ko, MD, MS, and David Waipigi, PhD, of the Department of Cardiology at Boston Children’s Hospital and Harvard Medical School; Derek C. Angus, MD, MPH, University of Pittsburgh Medical Center; R. Scott Watson, MD, MPH, University of Washington School of Medicine and Seattle Children’s Hospital;
sauce:
University of Pennsylvania School of Nursing
Reference magazines:
Carly, M.A.Q. Others. (2026) Sedative choice and neurocognitive outcomes after critical illness in early childhood. JAMA network open DOI: 10.1001/jamanetworkopen.2026.13599. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2849142
