Welcome to the 9th EAPS Congress Programme Scheduling

Abstract Body

The rates of overweight and obesity are skyrocketing in both adults and children. It is even forecasted that 51% of the world population will be obese by 2030. It is well known that obesity has influence on drug distribution and metabolism. In children, both obesity and development impact drug disposition, but the exact interplay is still unclear and individualized dosing guidelines are missing. This knowledge gap puts the obese children at risk of drug treatment failure or drug toxicity.

Optimal weight-based dosing strategies vary by drug and age, but investigating every prescribed medicine is not feasible. A proposed dosing strategy in obese children is allometric scaling. Allometric scaling refers to dosing based on body size scaled to a fixed exponent. However, it remains unclear which anthropometric measure of size is most appropriate for scaling, and it is likely that none of the measures of size will be appropriate for all drugs.

Moreover, in critically ill children, drug disposition also shows variability due to critical illness, like edema, acute kidney injury, augmented renal clearance and inflammation. The interplay between age, obesity and critical illness poses the prescribing pediatric intensivist and pharmacist for a difficult task to tailor dosing to the individual patient.

Learning objectives of this presentation will be:
Understand the impact of age, disease and obesity on drug disposition in critically ill, obese children

Understand the complexity of its interplay

Discuss the role of therapeutic drug monitoring to optimize dosing in this vulnerable population

Background and Aims

Post-pyloric tube feeding is often used in pediatrics, aiming for the improvement of feeding tolerance when observing hypomobility and delayed gastric emptying. This is a systematic review of methods of post-pyloric tube placement to clarify the advantages and problems of each method in children.

Methods

We conducted a literature search to identify RCTs and quasi-RCTs involving children under the age of eighteen who require enteral nutrition. We searched CENTRAL, MEDLINE, EMBASE, and CINAHL, following the methodology for data collection and analysis in the Cochrane Handbook for Systematic Reviews. This review sought to include any methods for facilitating feeding tube placement.

Results

Among 15,670 papers extracted from the four databases, following the primary screening and duplicates removals, eight studies met the inclusion criteria. Six were single-center studies, and two were the study conducted in two sites. Primary interventions examined were prokinetic drugs in three studies, air injection into the stomach in three studies, pH monitoring device in one study, and magnetic tracking device in two studies. There was one study involving two interventions. When comparing controls with any types of methods, the initial success rate ranged from 62% to 97% in the intervention group, and 44% to 81% in the control group.

Conclusions

We found better success rates in any type of intervention, compared to the control group. Due to the heterogeneity in study subjects and interventional methods, and the small number of studies for each method, no strong conclusions could be made as to which method was the best.

Background and Aims

Research in paediatric intensive care (PICU) is important for improvements in the care delivered to critically ill children. Most studies conducted in PICU report in-PICU mortality as a summary statistic or an estimate such as a risk ratio. These estimates are at times adjusted for other variables, however, none of these studies report any reasons for the selection of the adjustment covariates.

When pooling these mortality rates by sex, we observe a higher rate of PICU mortality for females compared to males. This apparent increase in female mortality is not well understood.

The aim of this research is to apply causal reasoning to understand if the apparent increase of female mortality in PICU is driven by bias resulting from the selection of patient population in PICU, or there is a real effect of sex on mortality in PICU

Methods

We selected all PICU admissions in England from 1/1/2010 to 31/12/2019. We linked these records to Hospital Episode Statistics records for these children, to their mortality records, and to their mothers' records.

We defined our causal estimand to be the adjusted risk ratio in PICU mortality for females compared to males. We selected the variables for the adjusted risk ratio using Directed Acyclic Graphs. We demonstrate the use of Targeted Learning (causal machine learning) and compare it to traditional methods such as regression adjustment and the G-formula.

Results

Female sex can lead to higher risk of mortality in PICU.

Conclusions

To study PICU mortality, careful selection of confounders is needed to avoid biased estimates.