Day-Night Activity in Hospitalized Children after Major Surgery: An Analysis of 2271 Hospital Days

Sapna R Kudchadkar, Othman Aljohani, Jordan Johns, Andrew Leroux, Eman Alsafi, Ebaa Jastaniah, Allan Gottschalk, Nehal J. Shata, Ahmad Al-Harbi, Daniel Gergen, Anisha Nadkarni, Ciprian M Crainiceanu

Research output: Contribution to journalArticle

Abstract

Objectives: To characterize the day-night activity patterns of children after major surgery and describe differences in children's activity patterns between the pediatric intensive care unit (PICU) and inpatient floor setting. Study design: In this prospective observational study, we characterized the daytime activity ratio estimate (DARE; ratio between mean daytime activity [08:00-20:00] and mean 24-hour activity [00:00-24:00]) for children admitted to the hospital after major surgery. The study sample included 221 infants and children ages 1 day to 17 years admitted to the PICU at a tertiary, academic children's hospital. Subjects were monitored with continuous accelerometry from postoperative day 1 until hospital discharge. The National Health and Nutrition Examination Survey accelerometry data were utilized for normative data to compare DARE in a community sample of US children to hospitalized children. Results: The mean DARE over 2271 hospital days was 57.8%, with a significant difference between the average DARE during PICU days and inpatient floor days (56% vs 61%, P <.0001). The average subject DARE ranged from 43% to 73%. In a covariate-adjusted mixed effects model, PICU location, lower age, orthopedic or urologic surgery, and intubation time were associated with decreased DARE. Hospitalized children had significantly lower DARE than the National Health and Nutrition Examination Survey subjects in all age groups studied, with the largest difference in the youngest PICU group analyzed (6-9 years; 59% vs 75%, P <.0001). A subset analysis of children older than 2 years (n = 144) showed that DARE was <50% on 15% of hospital days. Conclusions: Children hospitalized after major surgery experience disruptions in day-night activity patterns during their hospital stay that may reflect disturbances in circadian rhythm.

Original languageEnglish (US)
JournalJournal of Pediatrics
DOIs
StatePublished - Jan 1 2019

Fingerprint

Hospitalized Child
Pediatric Intensive Care Units
Accelerometry
Nutrition Surveys
Inpatients
Circadian Rhythm
Intubation
Observational Studies
Orthopedics
Length of Stay
Age Groups
Prospective Studies

Keywords

  • accelerometry
  • actigraphy
  • activity
  • acute rehabilitation
  • children
  • circadian rhythms
  • critical illness
  • delirium
  • hospital
  • intensive care units
  • sleep
  • surgery

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Day-Night Activity in Hospitalized Children after Major Surgery : An Analysis of 2271 Hospital Days. / Kudchadkar, Sapna R; Aljohani, Othman; Johns, Jordan; Leroux, Andrew; Alsafi, Eman; Jastaniah, Ebaa; Gottschalk, Allan; Shata, Nehal J.; Al-Harbi, Ahmad; Gergen, Daniel; Nadkarni, Anisha; Crainiceanu, Ciprian M.

In: Journal of Pediatrics, 01.01.2019.

Research output: Contribution to journalArticle

Kudchadkar, Sapna R ; Aljohani, Othman ; Johns, Jordan ; Leroux, Andrew ; Alsafi, Eman ; Jastaniah, Ebaa ; Gottschalk, Allan ; Shata, Nehal J. ; Al-Harbi, Ahmad ; Gergen, Daniel ; Nadkarni, Anisha ; Crainiceanu, Ciprian M. / Day-Night Activity in Hospitalized Children after Major Surgery : An Analysis of 2271 Hospital Days. In: Journal of Pediatrics. 2019.
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abstract = "Objectives: To characterize the day-night activity patterns of children after major surgery and describe differences in children's activity patterns between the pediatric intensive care unit (PICU) and inpatient floor setting. Study design: In this prospective observational study, we characterized the daytime activity ratio estimate (DARE; ratio between mean daytime activity [08:00-20:00] and mean 24-hour activity [00:00-24:00]) for children admitted to the hospital after major surgery. The study sample included 221 infants and children ages 1 day to 17 years admitted to the PICU at a tertiary, academic children's hospital. Subjects were monitored with continuous accelerometry from postoperative day 1 until hospital discharge. The National Health and Nutrition Examination Survey accelerometry data were utilized for normative data to compare DARE in a community sample of US children to hospitalized children. Results: The mean DARE over 2271 hospital days was 57.8{\%}, with a significant difference between the average DARE during PICU days and inpatient floor days (56{\%} vs 61{\%}, P <.0001). The average subject DARE ranged from 43{\%} to 73{\%}. In a covariate-adjusted mixed effects model, PICU location, lower age, orthopedic or urologic surgery, and intubation time were associated with decreased DARE. Hospitalized children had significantly lower DARE than the National Health and Nutrition Examination Survey subjects in all age groups studied, with the largest difference in the youngest PICU group analyzed (6-9 years; 59{\%} vs 75{\%}, P <.0001). A subset analysis of children older than 2 years (n = 144) showed that DARE was <50{\%} on 15{\%} of hospital days. Conclusions: Children hospitalized after major surgery experience disruptions in day-night activity patterns during their hospital stay that may reflect disturbances in circadian rhythm.",
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AU - Kudchadkar, Sapna R

AU - Aljohani, Othman

AU - Johns, Jordan

AU - Leroux, Andrew

AU - Alsafi, Eman

AU - Jastaniah, Ebaa

AU - Gottschalk, Allan

AU - Shata, Nehal J.

AU - Al-Harbi, Ahmad

AU - Gergen, Daniel

AU - Nadkarni, Anisha

AU - Crainiceanu, Ciprian M

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N2 - Objectives: To characterize the day-night activity patterns of children after major surgery and describe differences in children's activity patterns between the pediatric intensive care unit (PICU) and inpatient floor setting. Study design: In this prospective observational study, we characterized the daytime activity ratio estimate (DARE; ratio between mean daytime activity [08:00-20:00] and mean 24-hour activity [00:00-24:00]) for children admitted to the hospital after major surgery. The study sample included 221 infants and children ages 1 day to 17 years admitted to the PICU at a tertiary, academic children's hospital. Subjects were monitored with continuous accelerometry from postoperative day 1 until hospital discharge. The National Health and Nutrition Examination Survey accelerometry data were utilized for normative data to compare DARE in a community sample of US children to hospitalized children. Results: The mean DARE over 2271 hospital days was 57.8%, with a significant difference between the average DARE during PICU days and inpatient floor days (56% vs 61%, P <.0001). The average subject DARE ranged from 43% to 73%. In a covariate-adjusted mixed effects model, PICU location, lower age, orthopedic or urologic surgery, and intubation time were associated with decreased DARE. Hospitalized children had significantly lower DARE than the National Health and Nutrition Examination Survey subjects in all age groups studied, with the largest difference in the youngest PICU group analyzed (6-9 years; 59% vs 75%, P <.0001). A subset analysis of children older than 2 years (n = 144) showed that DARE was <50% on 15% of hospital days. Conclusions: Children hospitalized after major surgery experience disruptions in day-night activity patterns during their hospital stay that may reflect disturbances in circadian rhythm.

AB - Objectives: To characterize the day-night activity patterns of children after major surgery and describe differences in children's activity patterns between the pediatric intensive care unit (PICU) and inpatient floor setting. Study design: In this prospective observational study, we characterized the daytime activity ratio estimate (DARE; ratio between mean daytime activity [08:00-20:00] and mean 24-hour activity [00:00-24:00]) for children admitted to the hospital after major surgery. The study sample included 221 infants and children ages 1 day to 17 years admitted to the PICU at a tertiary, academic children's hospital. Subjects were monitored with continuous accelerometry from postoperative day 1 until hospital discharge. The National Health and Nutrition Examination Survey accelerometry data were utilized for normative data to compare DARE in a community sample of US children to hospitalized children. Results: The mean DARE over 2271 hospital days was 57.8%, with a significant difference between the average DARE during PICU days and inpatient floor days (56% vs 61%, P <.0001). The average subject DARE ranged from 43% to 73%. In a covariate-adjusted mixed effects model, PICU location, lower age, orthopedic or urologic surgery, and intubation time were associated with decreased DARE. Hospitalized children had significantly lower DARE than the National Health and Nutrition Examination Survey subjects in all age groups studied, with the largest difference in the youngest PICU group analyzed (6-9 years; 59% vs 75%, P <.0001). A subset analysis of children older than 2 years (n = 144) showed that DARE was <50% on 15% of hospital days. Conclusions: Children hospitalized after major surgery experience disruptions in day-night activity patterns during their hospital stay that may reflect disturbances in circadian rhythm.

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KW - acute rehabilitation

KW - children

KW - circadian rhythms

KW - critical illness

KW - delirium

KW - hospital

KW - intensive care units

KW - sleep

KW - surgery

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