Retrospective cross-sectional review of survival rates in critically ill children admitted to a combined paediatric/neonatal intensive care unit in Johannesburg, South Africa, 2013-2015.
BMJ Open
; 6(6): e010850, 2016 06 03.
Article
en En
| MEDLINE
| ID: mdl-27259525
ABSTRACT
OBJECTIVE:
Report on survival to discharge of children in a combined paediatric/neonatal intensive care unit (PNICU). DESIGN ANDSETTING:
Retrospective cross-sectional record review.PARTICIPANTS:
All children (medical and surgical patients) admitted to PNICU between 1 January 2013 and 30 June 2015. OUTCOMEMEASURES:
Primary outcome-survival to discharge. Secondary outcomes-disease profiles and predictors of mortality in different age categories.RESULTS:
There were 1454 admissions, 182 missing records, leaving 1272 admissions for review. Overall mortality rate was 25.7% (327/1272). Mortality rate was 41.4% (121/292) (95% CI 35.8% to 47.1%) for very low birthweight (VLBW) babies, 26.6% (120/451) (95% CI 22.5% to 30.5%) for bigger babies and 16.2% (86/529) (95% CI 13.1% to 19.3%) for paediatric patients. Risk factors for a reduced chance of survival to discharge in paediatric patients included postcardiac arrest (OR 0.21, 95% CI 0.09 to 0.49), inotropic support (OR 0.085, 95% CI 0.04 to 0.17), hypernatraemia (OR 0.16, 95% CI 0.04 to 0.6), bacterial sepsis (OR 0.32, 95% CI 0.16 to 0.65) and lower respiratory tract infection (OR 0.54, 95% CI 0.30 to 0.97). Major birth defects (OR 0.44, 95% CI 0.26 to 0.74), persistent pulmonary hypertension of the new born (OR 0.44, 95% CI 0.21 to 0.91), metabolic acidosis (OR 0.23, 95% CI 0.12 to 0.74), inotropic support (OR 0.23, 95% CI 0.12 to 0.45) and congenital heart defects (OR 0.29, 95% CI 0.13 to 0.62) predicted decreased survival in bigger babies. Birth weight (OR 0.997, 95% CI 0.995 to 0.999), birth outside the hospital (OR 0.21, 95% CI 0.05 to 0.84), HIV exposure (OR 0.54, 95% CI 0.30 to 0.99), resuscitation at birth (OR 0.49, 95% CI 0.25 to 0.94), metabolic acidosis (OR 0.25, 95% CI 0.10 to 0.60) and necrotising enterocolitis (OR 0.23, 95% CI 0.12 to 0.46) predicted poor survival in VLBW babies.CONCLUSIONS:
Ongoing mortality review is essential to improve provision of paediatric critical care.Palabras clave
Texto completo:
1
Colección:
01-internacional
Banco de datos:
MEDLINE
Asunto principal:
Alta del Paciente
/
Unidades de Cuidado Intensivo Neonatal
/
Tasa de Supervivencia
/
Enfermedad Crítica
/
Hospitalización
/
Enfermedades del Recién Nacido
Tipo de estudio:
Etiology_studies
/
Observational_studies
/
Prevalence_studies
/
Prognostic_studies
/
Risk_factors_studies
/
Screening_studies
Límite:
Child
/
Female
/
Humans
/
Infant
/
Male
/
Newborn
País/Región como asunto:
Africa
Idioma:
En
Revista:
BMJ Open
Año:
2016
Tipo del documento:
Article
País de afiliación:
Sudáfrica