Kindergarten readiness assessment scores after having early-childhood respiratory failure (krasher) - up to 40% of pediatric intensive care unit (picu) patients acquire new morbidities during critical…

The National Institute of Child Health and Human Development awarded Case Western Reserve University $472,336 on September 3, 2026, under the Child Health and Human Development Extramural Research program (CFDA 93.865) to investigate long-term neurodevelopmental outcomes in pediatric intensive care unit (PICU) survivors using standardized school assessment scores.

The research (KRASHER—Kindergarten Readiness Assessment Scores after Having Early-Childhood Respiratory Failure) uses kindergarten readiness assessment scores from 14 local school districts integrated within the university's Child and Household Integrated Longitudinal Data (CHILD) system to measure objective PICU outcomes in children who received mechanical ventilation. The study examines benzodiazepine sedatives as a modifiable risk factor for poor long-term developmental outcomes, testing the hypothesis that prolonged benzodiazepine exposure during critical illness impairs school performance, paralleling known associations between general anesthetic exposure early in life and decreased academic achievement.

This approach addresses a significant research gap: PICU survivors rarely complete in-person follow-up testing years after discharge, making standardized administrative educational data a practical alternative outcome measure. The project draws on existing pilot data correlating sedation exposure during mechanical ventilation with kindergarten readiness scores.

The award period runs through August 31, 2028, with work performed in Cleveland, Ohio. Case Western Reserve University's Office of Research Administration administers the award in affiliation with University Hospitals of Cleveland.

Kindergarten readiness assessment scores after having early-childhood respiratory failure (krasher) - up to 40% of pediatric intensive care unit (picu) patients acquire new morbidities during critical illness. Research into their exact rates, mechanisms and treatments is hampered by difficulty in getting picu survivors to undergo in-person testing years later. Our innovative approach is to use the results of standardized school testing as an objective, practical picu outcome measure. We are uniquely positioned to do this because we have "kindergarten readiness assessment" (KRA) scores from 14 local school districts available in our child and household integrated longitudinal data" (child) system, which integrates data from administrative agencies across our county. Our overall hypothesis is that benzodiazepine sedatives are a modifiable risk factor for poor long-term picu outcomes. Most picu patients on invasive mechanical ventilation (IMV) receive these drugs for days to weeks. The impact of these prolonged exposures on the developing brain is unknown, but exposure to general anesthetics - which work through the same receptors in the brain - early in life for even a few hours is associated with decreased school performance. We published a pilot study of KRA scores of children who received sedation while on IMV at age