Treatment of Children With Cancer and/or Hematopoietic Stem Cell Transplantation in the Intensive Care Unit: Experience at a Large European Pediatric Cancer Center.

Pediatric cancer treatment and hematopoietic stem cell transplantation (HSCT) carry considerable risks of morbidity. We conducted a single-center retrospective analysis of intensive care unit (ICU) admissions in unselected children and adolescents treated for cancer or undergoing HSCT. In a 10-year time period, 140 patients had 188 ICU admissions for a life-threatening condition. Main reasons for ICU admission were respiratory or cardiovascular insufficiency and sepsis. Mortality in the ICU was 19.1% and related to organ failure or acute complications in 77.8% and progress of the underlying malignancy in 22.2%. Mortality rates at 30, 100, and 365 days after discharge from the ICU were 24.5%, 30.9%, and 39.9%. Kaplan-Meier survival probabilities at 5 and 10 years were 46.4% and 39.8%, respectively. Multivariable analysis revealed the number of failed organ systems, the number of prior ICU stays, and days spent in the ICU as parameters independently associated with death. Taken together, the outcome of pediatric cancer and/or HSCT patients admitted to the ICU for life-threatening conditions was not as dismal as reported elsewhere. Most patients benefitted from ICU care, and survival was predominantly compromised by the evolution of complications.

Vaccination against influenza at a European pediatric cancer center: immunization rates and attitudes among staff, patients, and their families.

BACKGROUND: Influenza is an important cause of infectious morbidity in pediatric cancer patients. We conducted a single-center survey to explore adherence and attitudes towards the recommended annual influenza vaccination. METHODS: Self-administered, standardized questionnaires were distributed to 143 staff members and 264 families. Items analyzed included demographic data, knowledge about influenza, history of prior influenza infections and vaccinations, routes of information and education, and attitudes towards the recommended influenza. Variables associated with vaccination were explored by univariate and multivariate analyses. RESULTS: One hundred six staff members with patient contact and 139 primary caretakers completed the questionnaire. Fifty-nine percent of staff members and 60% of the caretakers provided correct answers to all four knowledge questions; 32 and 54% reported a history of prior influenza, and 61 and 47% had received at least one influenza vaccination in the past. Vaccination rates for the previous season were 47, 34, 30, 25, and 29% in staff members, primary caretakers, their partners, diseased children, and their siblings, respectively. Main motivations (>75% in ≥ 1 cohort) for vaccination were prevention of influenza disease and concerns to transmit it to others (77-100%) and reasons for not being immunized concerns of adverse effects and use of alternative protection (33-83%). Variables significantly associated with vaccination by multivariate analysis included receipt of influenza vaccinations in the past (OR 2.2-20.5), recommendations by health care providers (OR 4.8-45.5), a lower level of education (caretakers; OR 2.2), and younger age (children; OR 0.9). CONCLUSIONS: The results of this survey indicate insufficient vaccination rates and provide potential approaches for improved vaccination strategies in the setting of pediatric cancer care.