• Eleonore S V de Sonnaville, van WoenselJob B MJBMAmsterdam UMC, University of Amsterdam, Emma Children's Hospital, Department of Pediatric Intensive Care, Amsterdam Reproduction and Development Research Institute, Meibergdreef 9, Amsterdam, The Netherlands., Johannes B van Goudoever, Marieke H Otten, Lorynn Teela, Cornelieke S H Aarnoudse-Moens, Terheggen-LagroSuzanne W JSWJAmsterdam UMC, University of Amsterdam, Emma Children's Hospital, Department of Pediatric Pulmonology and Allergy, Amsterdam Reproduction and Development & Infection and Immunity Research Institutes, Meibergdreef 9, Amsterdam,, Annelies E van der Hulst, Marc Engelen, Marsh Kӧnigs, Jaap Oosterlaan, Hennie Knoester, and Emma Children’s Hospital Amsterdam UMC Follow Me Program Consortium.
• Amsterdam UMC, University of Amsterdam, Emma Children's Hospital, Department of Pediatric Intensive Care, Amsterdam Reproduction and Development Research Institute, Meibergdreef 9, Amsterdam, The Netherlands.
• Pediatr Crit Care Me. 2023 Jun 1; 24 (6): 484498484-498.

ObjectivesMorbidity after PICU admission for critical illness is a growing concern. Sequelae may occur in various domains of functioning and can only appropriately be determined through structured follow-up. Here, we describe the process of designing and implementing a structured multidisciplinary follow-up program for patients and their parents after PICU admission and show the first results illustrating the significance of our program.DesignProspective observational cohort study.SettingOutpatient PICU follow-up clinic.PatientsPatients 0-18 years old admitted to our PICU.InterventionsNone.Measurements And Main ResultsIn our structured multidisciplinary follow-up program, follow-up care is provided by a pediatric intensivist and psychologist and in addition, depending on patient's critical illness and received PICU treatment(s), by a pediatric pulmonologist, cardiologist, neurologist, and/or neuropsychologist. All consultations are scheduled consecutively. Collected data are stored in a hospital-wide data warehouse and used for yearly health care evaluation sessions as well as scientific research. Challenges in organizing this follow-up program include technological challenges, providing time-efficient care, participation rate, and completeness of questionnaires. In our experience, a dedicated team is essential to tackle these challenges. Our first results, obtained in 307 of 388 referred patients (79.1%), showed the diversity of problems arising after PICU discharge, including physical, neurocognitive, and psychosocial sequelae. In addition, our data also reflected the risk of psychosocial problems among parents. Within the limited operation time of our follow-up program, the program has evolved based on our experiences and the data collected.ConclusionsWe successfully developed and implemented a structured multidisciplinary follow-up program for patients and their parents after PICU admission. This program may help to timely initiate appropriate interventions, improve the standard of care during and after PICU admission, and facilitate scientific research on outcome and prognosis after PICU admission.Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies.

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