Maayke Hunfeld

250 Chapter 8 Standardized interviews are held, and the child undergoes a physical exam and a neurological exam. Neuropsychological assessments as well as ancillary tests are performed on indication. Thereafter, the guideline recommends screening for problems at the ages of 5-6, 11-12 and 15-17 years, using validated psychological and neuropsychological questionnaires. The Netherlands is a relatively small country with a good infrastructure, and medical care paid for by health insurance companies, which means that follow-up care with on-site visits is easily realized. By providing structured follow-up, problems can be detected in an early stage and targeted therapeutic interventions can be offered to improve outcomes and reduce costs, both direct and indirect costs. Besides a national guideline, there is a need for an international guideline. The above-describe P-COSCA (75) was designed for research purposes and not for primary care, and does not address follow-up into adulthood. In our opinion, a standardized international follow-up program should include follow-up moments at fixed time points with physical, neurological and neuropsychological assessments; it should also include monitoring by an educational psychologist of these children’s development into adulthood, which may provide parents a realistic view of the strengths and weakness in their child’s intellectual functioning. Neuropsychological assessment should at least include intelligence scores, attention, processing speed, memory and executive functioning. Moreover, psychosocial functioning, QoL and participation, may add useful information regarding the functioning of OHCA children in daily life. One possible way to achieve international guidelines is to establish a long-term follow-up program within multicenter international collaborations such as the Pediatric Resuscitation PediRES-Q, in which our PICU department participates. In this collaborative (PI: Vinay Nadkarni, The Children’s Hospital of Philadelphia), many pre- arrest, arrest and post-arrest data are collected in a web-based database. Another possibility is collaboration of members of the EPNS/ESPNIC. The P-COSCA paper might be used as a starting point and can be further elaborated. This will be a great challenge: In many countries the distance to a hospital is too great, which hampers on-site visits of patients and their caregivers. Moreover, many hospitals outside the Netherlands do not receive financial compensation for this follow-up program. Furthermore, there is little interest from PICUs in organizing a follow-up program. National and international guidelines not only provide insight into the long-term outcome of children after OHCA in large groups and per age category, but have more advantages: In the study presented in chapter 7, we explored the association between PCPC and neuropsychological outcome, but found it hard to draw a solid conclusion because of the small sample size. Implementing a follow-up guideline widely generates many outcome data, providing the opportunity to examine the