Pediatric Neurogenic Stunned Myocardium: A Systematic Review and Pooled Individual-Level Analysis

BACKGROUND Neurogenic stunned myocardium (NSM) is a reversible cardiac dysfunction after acute neurological injury that is well described in adults but poorly characterized in children. OBJECTIVE The purpose of this study was to characterize pediatric NSM and identify factors associated with neurological outcome using individual patient data (IPD). METHODS A systematic review and pooled individual-level analysis were conducted according to Meta-analysis Of Observational Studies in Epidemiology (MOOSE) guidelines. PubMed, Web of Science, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) were searched from inception to November 2025 for studies reporting patients ≤ 18 years with NSM and available outcome data. Demographic, neurological, and cardiac variables were extracted. Functional outcomes were assessed using the modified Rankin Scale (mRS). RESULTS A total of 29 studies comprising 38 patients were included (mean age 7.7 years). The mean time to NSM onset was 60.8 h after neurological injury. Ventricular dysfunction occurred in 94.7%, commonly basal hypokinesis. Favorable outcome (mRS 0-2) occurred in 71.1%, while cardiac arrest occurred in 26.3% and mortality in 23.7%. Subarachnoid hemorrhage was associated with a worse outcome, whereas absence of pupil abnormalities and preserved reflexes were associated with a favorable outcome. CONCLUSIONS Pediatric NSM is usually reversible with favorable neurological outcomes but remains associated with significant morbidity and mortality. Early recognition and multidisciplinary management may improve outcomes. Larger prospective studies are needed to refine prognostic stratification.