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Therefore, we hypothesized that similar pediatric biomarkers reflect acute brain injury as in adult delirium. We observed pediatric cardiac surgery patients from neonatal age to 18\u00a0years, who were admitted to our pediatric intensive care unit after cardiovascular operations between October 2019 to June 2020, up to post-operative day 3 (4\u00a0days total). We recorded age, sex, risk score (Risk Adjustment in Congenital Heart Surgery [RACHS-1]), midazolam\/dexmedetomidine\/fentanyl dosage, and pediatric Sequential Organ Failure Assessment (pSOFA). Richmond Agitation-Sedation Scale (RASS), Cornell Assessment of Pediatric Delirium (CAPD), Face, Leg, Activity, Consolability (FLACC) behavioral scale, and Withdrawal Assessment Tool (WAT-1) scales were used and serum sampling for neuron specific enolase (NSE) was conducted. Consciousness status was considered hierarchical (coma\u2009&gt;\u2009delirium\u2009&gt;\u2009normal) and associations between conscious status and NSE were conducted by hierarchical Bayesian modeling. We analyzed 134 data points from 40 patients (median age 12\u00a0months). In the multi-regression model, NSE was positively associated with coma [posterior odds ratio (OR)\u2009=\u20091.1, 95% credible interval (CrI) 1.01\u20131.19] while pSOFA [posterior OR\u2009=\u20091.63, 95% CrI 1.17\u20132.5], midazolam [posterior OR\u2009=\u20091.02, 95% CrI 1.01\u20131.04], and dexmedetomidine [posterior OR\u2009=\u20099.52, 95% CrI 1.02\u2013108.85] were also associated. We also evaluated consciousness state probability at each NSE concentration and confirmed both that consciousness was hierarchically sorted and CAPD scores were also associated with NSE [posterior OR\u2009=\u20091.32, 95% CrI 1.09\u20131.58]. \u201cEye contact\u201d (r\u2009=\u20090.55) was the most correlated component with NSE within the pain, withdrawal syndrome, and PD items. PD within the hierarchy of consciousness (coma, delirium, normal) and CAPD scores are associated with brain injury marker levels. Using pediatric delirium assessment tools for monitoring brain injury, especially eye contact, is a reliable method for observing PD.<\/jats:p>","DOI":"10.1038\/s41598-022-22702-2","type":"journal-article","created":{"date-parts":[[2022,11,4]],"date-time":"2022-11-04T12:04:58Z","timestamp":1667563498000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Pediatric delirium is associated with increased brain injury marker levels in cardiac surgery patients"],"prefix":"10.1038","volume":"12","author":[{"given":"Yujiro","family":"Matsuishi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Haruhiko","family":"Hoshino","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuki","family":"Enomoto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nobutake","family":"Shimojo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Muneaki","family":"Matsubara","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hideyuki","family":"Kato","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bryan J.","family":"Mathis","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kojiro","family":"Morita","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuji","family":"Hiramatsu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yoshiaki","family":"Inoue","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2022,11,4]]},"reference":[{"issue":"2","key":"22702_CR1","doi-asserted-by":"publisher","first-page":"117","DOI":"10.1097\/ACO.0000000000000061","volume":"27","author":"CH Brown","year":"2014","unstructured":"Brown, C. 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