Neurological Pupil Index and Outcome After Cardiac Arrest in Children: Single-Center, Retrospective Cohort…

Cohort studyPediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies· Aug 2026

Neurological Pupil Index and Outcome After Cardiac Arrest in Children: Single-Center, Retrospective Cohort, 2018-2023.

Maya R Silver, Hongyan Liu, Alexis Z Tomlinson … Matthew P Kirschen

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Resuscitation & Cardiac ArrestCohort studyPrognosisQ1IF 2.8

Abnormal pupillary reactivity predicted unfavorable outcome after pediatric cardiac arrest with moderate accuracy

Neurological Pupil Index and Outcome After Cardiac Arrest in Children: Single-Center, Retrospective Cohort, 2018-2023.

Maya R Silver … Matthew P Kirschen

Pediatric critical care medicine · Aug 2026 · Q1 in Critical Care

Purpose

To determine the association between abnormal pupillary reactivity using automated infrared pupillometry and unfavorable outcome after pediatric cardiac arrest (cardiac arrest).

Methods

We identified 127 patients 18 years old or younger with 8464 pupillary assessments, greater than or equal to 2 measured within 72 hours after return of circulation (ROC).

n = 127 patients

Results

abnormal pupil reactivity predicted bad outcomes with moderate accuracy

66%

Sensitivity

79%

Specificity

More results

Unfavorable outcome was hospital discharge Pediatric Cerebral Performance Category of 4-6 and increase greater than or equal to 1 from pre-cardiac arrest status.

We explored the diagnostic performance of abnormal NPi for categorizing unfavorable outcome in the first 72 hours post-ROC, and at the time periods of 0-12, 12-24, 24-48, and 48-72 hours.

More results

In the mixed-effects model, unfavorable outcome was associated with lower NPi values that decreased over time (interaction of time from ROC and outcome β = -0.02; p < 0.001).

Through group-based trajectory modeling we identified a subgroup of patients with favorable outcome whose NPi was initially abnormal but subsequently improved over time.

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Conclusion · 1 of 2

In our 2018-2023 experience, the presence of at least two NPi values less than 3 post-cardiac arrest was associated with unfavorable outcome, with an acceptable level of diagnostic characterization.

Conclusion · 2 of 2

Of note, some patients with initially lower NPi values improved over time and had favorable outcome.

Neurological Pupil Index and Outcome After Cardiac Arrest in Children: Single-Center, Retrospective Cohort, 2018-2023.

Neurological Pupil Index and Outcome After Cardiac Arrest in Children: Single-Center, Retrospective Cohort, 2018-2023.

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