{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T09:05:04Z","timestamp":1784106304906,"version":"3.55.0"},"reference-count":35,"publisher":"American Academy of Pediatrics (AAP)","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2016,3,1]]},"abstract":"<jats:p>Delirium in children is common but not widely understood by pediatric practitioners, often leading to underdiagnosis and lack of treatment. This presents a significant challenge in the young patients in the PICU who are most at risk for delirium and in whom the core features of delirium are difficult to assess and treat. However, because of the potential increased morbidity and mortality associated with untreated delirium in adults and children, it remains important to address it promptly. The literature for delirium in this age group is limited. Here we present the case of an infant with multiple underlying medical risk factors who exhibited waxing and waning motor restlessness with disrupted sleep-wake cycles contributing significantly to destabilization of vital parameters. Making a diagnosis of delirium was key to guiding further treatment. After appropriate environmental interventions are implemented and underlying medical causes are addressed, antipsychotic medications, although not Food and Drug Administration\u2013approved in infants, are the mainstay of pharmacotherapy for delirium in older age groups. They may lengthen corrected QT interval (QTc) intervals, presenting a challenge in infants who frequently have other coexisting risks for QTc prolongation, as in our case. The risk from QTc prolongation needs to be balanced against that from untreated delirium. Low doses of risperidone were successfully used in this patient and without side effects or worsening of QTc interval. This case illustrates the importance of increased recognition of delirium in children, including infants, and the role for cautious consideration of atypical antipsychotics in the very young.<\/jats:p>","DOI":"10.1542\/peds.2015-1940","type":"journal-article","created":{"date-parts":[[2016,2,3]],"date-time":"2016-02-03T01:50:36Z","timestamp":1454464236000},"source":"Crossref","is-referenced-by-count":33,"title":["Diagnosis and Management of Delirium in Critically Ill Infants: Case Report and Review"],"prefix":"10.1542","volume":"137","author":[{"given":"Khyati","family":"Brahmbhatt","sequence":"first","affiliation":[{"name":"Department of Psychiatry, University of California, San Francisco, San Francisco, California; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emily","family":"Whitgob","sequence":"additional","affiliation":[{"name":"Fellow in Developmental-Behavioral Pediatrics, Division of Neonatal and Developmental Medicine, Stanford University School of Medicine, Lucile Packard Children's Hospital."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"417","published-online":{"date-parts":[[2016,3,1]]},"reference":[{"key":"2021120919105267300_B1","doi-asserted-by":"crossref","DOI":"10.1176\/appi.books.9780890425596","volume-title":"Diagnostic and Statistical Manual of Mental Disorders","author":"American Psychiatric Association","year":"2013","edition":"5th ed."},{"issue":"9","key":"2021120919105267300_B2","doi-asserted-by":"crossref","first-page":"2196","DOI":"10.1097\/CCM.0b013e31829a6f1e","article-title":"Implementing delirium screening in the ICU: secrets to success.","volume":"41","author":"Brummel","year":"2013","journal-title":"Crit Care Med"},{"issue":"4","key":"2021120919105267300_B3","doi-asserted-by":"crossref","first-page":"1005","DOI":"10.1017\/S1478951514000947","article-title":"Delirium screening anchored in child development: The Cornell Assessment for Pediatric Delirium.","volume":"13","author":"Silver","year":"2015","journal-title":"Palliat Support Care"},{"issue":"7","key":"2021120919105267300_B4","doi-asserted-by":"crossref","first-page":"595","DOI":"10.1001\/jamapediatrics.2014.125","article-title":"Delirium in the pediatric patient: On the growing awareness of its clinical interdisciplinary importance.","volume":"168","author":"Schieveld","year":"2014","journal-title":"JAMA Pediatr"},{"issue":"5","key":"2021120919105267300_B5","doi-asserted-by":"crossref","first-page":"352","DOI":"10.1089\/cap.2013.0001","article-title":"The diagnosis and management of delirium in infancy.","volume":"23","author":"Turkel","year":"2013","journal-title":"J Child Adolesc Psychopharmacol"},{"issue":"1","key":"2021120919105267300_B6","doi-asserted-by":"crossref","first-page":"150","DOI":"10.1097\/CCM.0b013e3181feb489","article-title":"Diagnosing delirium in critically ill children: Validity and reliability of the Pediatric Confusion Assessment Method for the Intensive Care Unit.","volume":"39","author":"Smith","year":"2011","journal-title":"Crit Care Med"},{"issue":"5","key":"2021120919105267300_B7","doi-asserted-by":"crossref","first-page":"446","DOI":"10.1016\/j.psym.2012.04.012","article-title":"Recognition of delirium on pediatric hospital services.","volume":"53","author":"Kelly","year":"2012","journal-title":"Psychosomatics"},{"issue":"4","key":"2021120919105267300_B8","doi-asserted-by":"crossref","first-page":"431","DOI":"10.1176\/jnp.15.4.431","article-title":"Delirium in children and adolescents.","volume":"15","author":"Turkel","year":"2003","journal-title":"J Neuropsychiatry Clin Neurosci"},{"issue":"4","key":"2021120919105267300_B9","doi-asserted-by":"crossref","first-page":"337","DOI":"10.1016\/j.jpsychores.2009.10.011","article-title":"Delirium in children and adolescents: a systematic review of the literature.","volume":"68","author":"Hatherill","year":"2010","journal-title":"J Psychosom Res"},{"issue":"14","key":"2021120919105267300_B10","doi-asserted-by":"crossref","first-page":"1753","DOI":"10.1001\/jama.291.14.1753","article-title":"Delirium as a predictor of mortality in mechanically ventilated patients in the intensive care unit.","volume":"291","author":"Ely","year":"2004","journal-title":"JAMA"},{"key":"2021120919105267300_B11","doi-asserted-by":"crossref","first-page":"h2538","DOI":"10.1136\/bmj.h2538","article-title":"Outcome of delirium in critically ill patients: systematic review and meta-analysis.","volume":"350","author":"Salluh","year":"2015","journal-title":"BMJ"},{"issue":"3","key":"2021120919105267300_B12","doi-asserted-by":"crossref","first-page":"593","DOI":"10.1016\/j.ccc.2009.05.002","article-title":"Delirium: an emerging frontier in the management of critically ill children.","volume":"25","author":"Smith","year":"2009","journal-title":"Crit Care Clin"},{"issue":"11","key":"2021120919105267300_B13","doi-asserted-by":"crossref","first-page":"1843","DOI":"10.1007\/s00134-009-1652-8","article-title":"Diagnostic considerations regarding pediatric delirium: a review and a proposal for an algorithm for pediatric intensive care units.","volume":"35","author":"Schieveld","year":"2009","journal-title":"Intensive Care Med"},{"issue":"1","key":"2021120919105267300_B14","doi-asserted-by":"crossref","first-page":"220","DOI":"10.1097\/CCM.0b013e318202e635","article-title":"On pediatric delirium and the use of the Pediatric Confusion Assessment Method for the Intensive Care Unit.","volume":"39","author":"Schieveld","year":"2011","journal-title":"Crit Care Med"},{"issue":"11","key":"2021120919105267300_B15","doi-asserted-by":"crossref","first-page":"1982","DOI":"10.1007\/s00134-010-1989-z","article-title":"Refractory agitation as a marker for pediatric delirium in very young infants at a pediatric intensive care unit.","volume":"36","author":"Schieveld","year":"2010","journal-title":"Intensive Care Med"},{"issue":"6","key":"2021120919105267300_B16","doi-asserted-by":"crossref","first-page":"1033","DOI":"10.1007\/s00134-007-0637-8","article-title":"Pediatric delirium in critical illness: phenomenology, clinical correlates and treatment response in 40 cases in the pediatric intensive care unit.","volume":"33","author":"Schieveld","year":"2007","journal-title":"Intensive Care Med"},{"issue":"1","key":"2021120919105267300_B17","doi-asserted-by":"crossref","first-page":"51","DOI":"10.1016\/j.ccc.2012.10.007","article-title":"Preventing delirium in the intensive care unit.","volume":"29","author":"Brummel","year":"2013","journal-title":"Crit Care Clin"},{"issue":"4","key":"2021120919105267300_B18","doi-asserted-by":"crossref","first-page":"87","DOI":"10.4330\/wjc.v5.i4.87","article-title":"Drugs to be avoided in patients with long QT syndrome: Focus on the anaesthesiological management.","volume":"5","author":"Fazio","year":"2013","journal-title":"World J Cardiol"},{"issue":"3","key":"2021120919105267300_B19","doi-asserted-by":"crossref","first-page":"253","DOI":"10.1176\/appi.psy.48.3.253","article-title":"Subtypes of pediatric delirium: a treatment algorithm.","volume":"48","author":"Karnik","year":"2007","journal-title":"Psychosomatics"},{"issue":"9","key":"2021120919105267300_B20","doi-asserted-by":"crossref","first-page":"976","DOI":"10.1164\/rccm.200706-857OC","article-title":"Children\u2019s factual and delusional memories of intensive care.","volume":"177","author":"Colville","year":"2008","journal-title":"Am J Respir Crit Care Med"},{"issue":"4","key":"2021120919105267300_B21","doi-asserted-by":"crossref","first-page":"392","DOI":"10.1097\/01.chi.0000153231.64968.1a","article-title":"Delirium in severely ill young children in the pediatric intensive care unit (PICU).","volume":"44","author":"Schieveld","year":"2005","journal-title":"J Am Acad Child Adolesc Psychiatry"},{"issue":"6","key":"2021120919105267300_B22","doi-asserted-by":"crossref","first-page":"1121","DOI":"10.1002\/pbc.24917","article-title":"Neuroblastoma and pediatric delirium: a case series.","volume":"61","author":"Traube","year":"2014","journal-title":"Pediatr Blood Cancer"},{"issue":"10","key":"2021120919105267300_B23","doi-asserted-by":"crossref","first-page":"1172","DOI":"10.1176\/appi.ajp.2010.09111606","article-title":"Infant delirium in pediatric critical care settings.","volume":"167","author":"Silver","year":"2010","journal-title":"Am J Psychiatry"},{"issue":"7","key":"2021120919105267300_B24","doi-asserted-by":"crossref","first-page":"1592","DOI":"10.1097\/CCM.0000000000000326","article-title":"Sedation, sleep promotion, and delirium screening practices in the care of mechanically ventilated children: a wake-up call for the pediatric critical care community.","volume":"42","author":"Kudchadkar","year":"2014","journal-title":"Crit Care Med"},{"issue":"1","key":"2021120919105267300_B25","doi-asserted-by":"crossref","first-page":"34","DOI":"10.1097\/00004630-199601000-00009","article-title":"The use of haloperidol in the agitated, critically ill pediatric patient with burns.","volume":"17","author":"Brown","year":"1996","journal-title":"J Burn Care Rehabil"},{"issue":"10","key":"2021120919105267300_B26","doi-asserted-by":"crossref","first-page":"1602","DOI":"10.1007\/s00134-014-3446-x","article-title":"Adverse events of haloperidol for the treatment of delirium in critically ill children.","volume":"40","author":"Slooff","year":"2014","journal-title":"Intensive Care Med"},{"issue":"2","key":"2021120919105267300_B27","doi-asserted-by":"crossref","first-page":"126","DOI":"10.1089\/cap.2011.0084","article-title":"Atypical antipsychotic medications to control symptoms of delirium in children and adolescents.","volume":"22","author":"Turkel","year":"2012","journal-title":"J Child Adolesc Psychopharmacol"},{"issue":"4","key":"2021120919105267300_B28","doi-asserted-by":"crossref","first-page":"267","DOI":"10.1007\/s40272-014-0078-0","article-title":"The pharmacologic management of delirium in children and adolescents.","volume":"16","author":"Turkel","year":"2014","journal-title":"Paediatr Drugs"},{"issue":"6","key":"2021120919105267300_B29","doi-asserted-by":"crossref","first-page":"e413","DOI":"10.1097\/PCC.0b013e31820ac2bf","article-title":"Recurrent delirium after surgery for congenital heart disease in an infant.","volume":"12","author":"Madden","year":"2011","journal-title":"Pediatr Crit Care Med"},{"issue":"10","key":"2021120919105267300_B30","doi-asserted-by":"crossref","first-page":"1013","DOI":"10.1056\/NEJMra032426","article-title":"Drug-induced prolongation of the QT interval.","volume":"350","author":"Roden","year":"2004","journal-title":"N Engl J Med"},{"issue":"3","key":"2021120919105267300_B31","doi-asserted-by":"crossref","first-page":"1136","DOI":"10.1161\/01.CIR.84.3.1136","article-title":"The long QT syndrome. Prospective longitudinal study of 328 families.","volume":"84","author":"Moss","year":"1991","journal-title":"Circulation"},{"issue":"7","key":"2021120919105267300_B32","doi-asserted-by":"crossref","first-page":"1685","DOI":"10.1016\/0735-1097(95)60383-2","article-title":"Risk of cardiac events in family members of patients with long QT syndrome.","volume":"26","author":"Zareba","year":"1995","journal-title":"J Am Coll Cardiol"},{"key":"2021120919105267300_B33","author":"Hale"},{"issue":"1","key":"2021120919105267300_B34","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1016\/j.jaac.2014.10.002","article-title":"Corrected QT changes during antipsychotic treatment of children and adolescents: a systematic review and meta-analysis of clinical trials.","volume":"54","author":"Jensen","year":"2015","journal-title":"J Am Acad Child Adolesc Psychiatry"},{"issue":"1","key":"2021120919105267300_B35","doi-asserted-by":"crossref","first-page":"62","DOI":"10.1097\/01.jcp.0000104913.75206.62","article-title":"A randomized evaluation of the effects of six antipsychotic agents on QTc, in the absence and presence of metabolic inhibition.","volume":"24","author":"Harrigan","year":"2004","journal-title":"J Clin Psychopharmacol"}],"container-title":["Pediatrics"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/doi\/10.1542\/peds.2015-1940\/925667\/peds_20151940.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/publications.aap.org\/pediatrics\/article-pdf\/doi\/10.1542\/peds.2015-1940\/925667\/peds_20151940.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,12,10]],"date-time":"2021-12-10T05:31:18Z","timestamp":1639114278000},"score":1,"resource":{"primary":{"URL":"https:\/\/publications.aap.org\/pediatrics\/article\/137\/3\/e20151940\/81391\/Diagnosis-and-Management-of-Delirium-in-Critically"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2016,3,1]]},"references-count":35,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2016,3,1]]},"published-print":{"date-parts":[[2016,3,1]]}},"URL":"https:\/\/doi.org\/10.1542\/peds.2015-1940","relation":{},"ISSN":["0031-4005","1098-4275"],"issn-type":[{"value":"0031-4005","type":"print"},{"value":"1098-4275","type":"electronic"}],"subject":[],"published":{"date-parts":[[2016,3,1]]},"article-number":"e20151940"}}