Elsevier

The Journal of Pediatrics

Volume 209, June 2019, Pages 190-197.e1
The Journal of Pediatrics

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

https://doi.org/10.1016/j.jpeds.2019.01.054Get rights and content

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.

Section snippets

Methods

The reporting of this study conforms to the STROBE statement for reporting of observational studies.26 Children were eligible for inclusion if they were admitted to the Johns Hopkins PICU after major cardiac, orthopedic, or urologic surgery. We chose to include these groups of surgical patients because they comprise a large proportion of surgical PICU admits; capture a wide range of ages while minimizing the heterogeneity in comorbid conditions that could confound the DARE (ie, neurosurgery,

Results

During the study period, 250 children were enrolled in the PICU, 221 of whom met the criteria for completion of the study with >24 hours of analyzable actigraphy data (n = 2271 hospital days). Eighty-four percent of eligible admissions (n = 333) were approached for informed consent during the study period and 90% of these patients were enrolled. Only 6 children dropped out of the study before hospital discharge owing to some discomfort in wearing the actigraphy watch. However, the watch was

Discussion

The results of this study confirm that children recovering from major surgery experience disturbances in day-night activity patterns both in the PICU and after transfer to the inpatient floor setting. As the first study to characterize day-night activity patterns in a large cohort of infants and children admitted to the hospital, we also demonstrate the feasibility of actigraphy for continuous monitoring in this setting. In addition, we describe the novel application of the DARE to characterize

Data Statement

Data sharing statement available at www.jpeds.com.

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    • Cited by (0)

    S.K. was funded by the National Center for Advancing Translational Sciences (5KL2RR025006), the American Thoracic Society Outstanding Early Stage Investigator Award, and the Foundation for Anesthesia Education and Research (FAER) Research in Fellowship Award. These funding sources provided support for conduct of the research but did not play a role in the study design, data collection, analysis, or decision to submit the paper for publication. The authors declare no conflicts of interest.

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