Incidence, Prevalence, Risk Factors, and Outcomes of ICU-Acquired Weakness Among Critically Ill Children: A Systematic Review and Meta-Analysis.

BackgroundICU-acquired weakness (ICUAW) is a common neuromuscular complication affecting both short- and long-terms health outcomes in critically ill children. To date, no comprehensive systematic review has synthesized evidence on ICUAW in pediatric populations. This systematic review aims to identify the incidence, prevalence, risk factors, and outcomes for ICUAW among critically ill children.MethodsThe review was conducted following JBI systematic review methodology and reported following the PRISMA guidelines. PubMed, CINAHL, Embase, and Scopus were searched for English-language original studies published from January 1, 2010, to October 14, 2025, including children aged 1 month-18 years in PICU/ICU settings diagnosed with ICUAW. Pooled incidence and prevalence were estimated using a random-effects meta-analysis. Risk factors and outcomes were narratively synthesized. Three ICUAW subtypes, including critical illness myopathy (CIM), critical illness polyneuropathy (CIP), and critical illness neuromyopathy (CINM), were synthesized separately. The JBI critical appraisal tools were used to apprise the quality of included studies.ResultsOf 2686 articles, 14 met inclusion criteria. The pooled incidence and prevalence were 2% (95% CI: 0.00-0.87), and 52% (95% CI: 0.32-0.70), respectively, with substantial between-study heterogeneity. Data synthesis identified 4 personal-, 13 disease-, and 17 treatment-related factors, and 11 biomarkers associated with ICUAW. ICUAW was associated with seven physical and hospital-related outcomes during hospitalization, whereas only reduced physical functioning and quality of life were identified as post-discharge outcomes.ConclusionThis review provides pooled estimates of ICUAW incidence and prevalence and identifies risk factors, and outcomes in children. Findings underscore the need for early detection and timely prevention of pediatric ICUAW. Clinicians should assess risk factors for and identify ICUAW using standardized diagnostic methods, specifying affected muscles and ICUAW subtypes. Future research is needed to develop and validate standardized criteria to enhance diagnostic precision and comparability across studies of ICUAW.