Risk Factors for Delirium in Pediatric Intensive Care Units: A Systematic Review and Meta-Analysis.

BACKGROUND

Delirium is a frequent and serious complication in critically ill children admitted in the pediatric intensive care units (PICUs). This systematic review and meta-analysis aimed to identify and quantify risk factors associated with delirium in the PICU.

METHODS

Searches were conducted across PubMed, Embase, Web of Science, and Scopus from inception to November 9, 2025. Observational studies reporting delirium in PICU settings were included. Univariate odds ratios were pooled using DerSimonian-Laird random-effects models.

RESULTS

Thirty-four studies were included. A total of 23 risk factors with at least five contributing studies were meta-analyzed. Significant predictors of delirium included younger age, developmental delay, neurological disorders, mechanical ventilation, prolonged ventilation, noninvasive ventilation, and multiple medication exposures, including benzodiazepines, opioids, dexmedetomidine, antiepileptics, and corticosteroids. Additional significant factors included vasoactive support, cyanotic heart disease, blood or component transfusion, physical restraints, and longer PICU stays. Sensitivity analyses showed robust findings for most predictors. Publication bias was minimal for most risk factors.

CONCLUSIONS

Multiple modifiable and nonmodifiable risk factors contribute to delirium in critically ill children. The use of univariate data and high heterogeneity are important limitations that limit firm conclusions from the present evidence.