• Kathryn E Kalata, Kristen R Miller, Yamila L Sierra, Tellen D Bennett, R Scott Watson, Peter M Mourani, and Aline B Maddux.
• Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO.
• Pediatr Crit Care Me. 2024 Dec 19.

ObjectivesTo describe frequency of, and risk factors, for change in caregiver employment among critically ill children with acute respiratory failure.DesignPreplanned secondary analysis of prospective cohort dataset, 2018-2021.SettingQuaternary Children's Hospital PICU.PatientsChildren who required greater than or equal to 3 days of invasive ventilation, survived hospitalization, and completed greater than or equal to 1 post-discharge survey.InterventionsNone.Measurements And Main ResultsWe measured change in caregiver employment 1 and 12 months post-discharge relative to pre-admission and, when present, change in caregiver identity defined by relationship to the patient. Data were collected by survey. We used logistic regression to identify factors associated with these changes. We evaluated 130 children, median age 6.4 years (interquartile range, 1.10-13.3 yr), 40 (30.8%) with a complex chronic condition (CCC), and 99 (76.2%) with normal pre-illness Functional Status Scale scores. Of 123 with 1-month post-discharge data, 25 of 123 (20.3%) experienced a change in caregiver employment and an additional 14 of 123 (11.4%) had a change in caregiver(s). Of 115 with 12-month post-discharge data, 33 of 115 (28.7%) experienced a change in caregiver employment and an additional 16 of 115 (13.9%) had a change in caregiver(s). After controlling for age, CCC, baseline caregiver employment, new morbidity at discharge, and social and economic index; higher maximum Pediatric Logistic Organ Dysfunction-2 score (odds ratio [OR], 1.19 [95% CI, 1.01-1.41]) and government insurance (OR, 3.85 [95% CI, 1.33-11.11]) were associated with the composite outcome of change in caregiver employment or caregiver(s) at 1-month post-discharge.ConclusionsAt 1 and 12 months post-discharge, more than one-in-five children who survived greater than or equal to 3 days of invasive ventilation had a change in caregiver employment and one-in-ten had a change in caregiver(s). Identification of risk factors, such as illness severity and social determinants of health, associated with a significant family change may improve our support of these families.Copyright © 2024 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies.

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