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Neurocognitive outcomes in children following immersion: a long-term study
  1. Maria Patricia Manglick1,
  2. Frank I Ross1,
  3. Mary-Clare Waugh2,
  4. Andrew J A Holland1,3,
  5. Daniel T Cass1,
  6. Soundappan S V Soundappan1,3
  1. 1 Department of Paediatric Surgery, The Children’s Hospital at Westmead, Sydney, New South Wales, Australia
  2. 2 Kids Rehabilitation Department, The Children’s Hospital at Westmead, Sydney, New South Wales, Australia
  3. 3 Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
  1. Correspondence to Mrs Maria Patricia Manglick, Department of Paediatric Surgery, The Children’s Hospital at Westmead, Sydney, NSW 2145, Australia; patricia.manglick{at}


Objective To investigate long-term neurocognitive outcomes after a near-drowning incident in children who were deemed neurologically intact on discharge from hospital.

Design A prospective cohort study of near-drowning children.

Setting 95 drowning and near-drowning admissions, 0–16 years of age, from January 2009 to December 2013, to The Children’s Hospital at Westmead, Sydney, NSW, Australia.

Participants 23 children both met the criteria and had parental consent for the study.

Main outcome measures Identification of the long-term deficits in behaviour, executive function, motor skills, communicative skills and well-being over a 5-year period. Assessment was undertaken at 3–6 months, 1 year, 3 years and 5 years after near-drowning at clinic visits. Physical developmental screening and executive function screening were done using Behavior Rating Inventory of Executive Function-Preschool version (BRIEF-P) and BRIEF.

Result 95 drowning and near-drowning episodes occurred during the study period. 10 (11%) children died, 28 were admitted to the paediatric intensive care unit and 64 directly to a ward. 3 children died in emergency department, 7 children had severe neurological deficit on discharge from the hospital. 23 were subsequently recruited into the study; 5 (22%) of these children had abnormalities in behaviour and/or executive function at some during their follow-up.

Conclusion Children admitted to hospital following a near-drowning event warrant long-term follow-up to identify any subtle sequelae which might be amenable to intervention to ensure optimal patient outcome.

  • Near-drowning
  • Long-term Effects
  • Neurocognitive Outcomes
  • Immersion

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  • Contributors MPM, DTC and SSVS were responsible for the concept, design and plan of the study. MPM and FIR acquired the data. MPM, SSVS, DTC and MCW interpreted the data. All authors reviewed, edited and critically revised several drafts and the final drafts for important content. All authors approved the final manuscript. SSVS and DTC supervised the study and MPM is the guarantor. Suzanne Benson, clinical psychologist and neuropsychologist, Kids Rehab Unit, provided advice, guidance and computerised analyses of the BRIEF-P and BRIEF (Behavior Rating Inventory of Executive Function) assessment.

  • Funding The study was conducted with financial support of the Department of Surgery, Centre for Trauma Care Prevention Education and Research, The Children’s Hospital at Westmead, Sydney.

  • Competing interests None declared.

  • Patient consent Signed consent of participation in the study was obtained from parents of patients as part of the application approval by the National Ethics Committee Australia.

  • Ethics approval The study protocol was approved by the National Human Research Ethics Committee and the Low Negligible Risk and Site Specific Application approval (LNR/SSA) by the Governance Research Services of the Children’s Hospital at Westmead, Sydney.

  • Provenance and peer review Not commissioned; externally peer reviewed.