Exercise and Sport Participation in Pediatric Hypertrophic Cardiomyopathy: A Changing Paradigm.

A child's admission to a pediatric or neonatal intensive care unit (PICU/NICU) is widely recognized as a highly stressful event for parents, often associated with significant psychological distress (). A growing body of research shows that this experience can lead to posttraumatic stress symptoms (PTSS) and posttraumatic stress disorder (PTSD), affecting approximately 10%–40% of parents of critically ill children (, ). Across multiple studies, mothers showed higher rates of PTSD than fathers, with prevalence estimates ranging from 15% to 48% for mothers and 4.3% to 19% for fathers (). When data from three studies were pooled, mothers were found to have significantly greater odds of developing PTSD compared to fathers (OR = 2.3; 95% CI: 1.3–4.1;  < 0.01) (). In recent years, there has been an increasing focus on the long-term sequelae of pediatric critical care treatment. The Post-Intensive Care Syndrome (PICS) concept was introduced in 2010 by the Society of Critical Care Medicine with a view to capturing cognitive, physical and psychological sequelae in adult ICU survivors (). It was later expanded to include pediatric patients and their families (PICS-p), acknowledging the interdependent recovery process between patients and their caregivers (, ). Emotional and psychological distress in parents is increasingly recognized as a core component of post-PICU outcomes. ICU diaries have been proposed as a low-cost, family-centered intervention to support emotional processing, enhance communication, and reduce trauma-related symptoms (, ). First introduced in Scandinavia in the 1970s and later adapted in Germany (, ), ICU diaries are now increasingly used in adult settings. While qualitative studies report high acceptance among families and staff in pediatric environments (–), quantitative evidence remains limited, particularly from randomized controlled trials (RCTs). The results of RCTs in adult ICU settings have been inconsistent regarding the impact of ICU diaries on PTSD symptoms in family members. A significant reduction ( = 0.03) among family members in an intervention group using ICU diaries was observed in one study (), while others reported no significant effects (, ). Meta-analyses also yielded inconsistent findings: Nydahl et al. reported a significant positive effect on family members (), whereas three other meta-analyses did not find a significant benefit (–). In pediatric settings, only two RCTs have hitherto been published (, ). One RCT demonstrated a significant ( = 0.04) reduction in PTSD symptoms among parents who used an online diary during their child's stay in a NICU (), whereas a RCT conducted in a PICU setting found no statistically significant differences between the diary group and the control group (). Beyond such external interventions, individual psychological resources may play a crucial role in shaping parental outcomes following a PICU stay. Resilience is recognized as the ability to adapt successfully to challenging situations (). A prospective study found that higher parental resilience had a positive effect on psychopathological outcomes, although this was moderated by perceived stress during the PICU stay (). Similarly, a prospective observational study reported a negative association between parental resilience and self-reported psychological symptoms, suggesting that resilience may serve as a useful marker of psychological risk following PICU stay (). During the implementation of PICU diaries for families in an interdisciplinary pediatric intensive care unit, a pilot study was conducted to support the design of future larger-scale trials aimed at improving family-centered care (FCC) and reducing long-term impairment in patients and their parents. To evaluate the feasibility of including multiple family members in a complex study design, data were collected on parental resilience, health-related quality of life in patients and parents, parental satisfaction with the PICU stay, and post-traumatic stress symptoms in parents and children (). Accordingly, this article provides methodological insights from this study and highlights its limitations and areas for improvement. It further reports on selected exploratory analyses derived from the broader pilot study, examining the potential effects of PICU diaries on rates of suspected PTSD among parents after PICU discharge, subgroup variation according to parental gender, and potential associations between parental resilience and PTSD outcomes. This work presents findings derived from a larger pilot RCT (). The parent trial was designed as a single-center, non-blinded, randomized controlled pilot study and was conducted in the 12-bed Pediatric Intensive Care Unit (PICU) of a university hospital between March 2023 and November 2024. The objective of the present analysis was to evaluate the feasibility of randomized controlled trials assessing the effect of PICU diaries on psychological outcomes, particularly symptoms of PTSD in parents