Background

Unlike in adults, many children surviving intensive care have the prospect of a full life with good quality. There is paucity of studies in assessing quality of life after discharge in children with acute respiratory illness . Hence the study.

Objectives

To assess long term health related quality of life in all PICU survivors with acute respiratory illness requiring invasive respiratory support, three to eight years after discharge

Methods

Premorbid well children who were ventilated for more than 48 hours for respiratory illness and survived were included. Quality of life assessment was done with the help of the Health Utility Index 2 which has 6 domains; sensation, mobility, emotion, cognition, self care and pain. Objective assessment was done by using HUI2 index. Outcome is classified as NORMAL(Score>0.99), FAIR( 0.89-0.99) and POOR (Score<0.89).

Results

146 children survived among the 259 required ventilation for > 48 hours. Six children died after discharge to hospital . HUI2 questionnaire details were obtained either through personal interview(n=24) or by telephonic interview (n=42).

HUI2 assessment was done for 66 children (Mean age 7.8± 2.6 years). Mean HUI2 score was 0.94±0.062. Majority of children are having good quality of life(84%) . Of 66, one child was having learning disability and was affected badly in 4 domains(Score of 0.69)

Most common affected domain is ‘Cognition’ followed by 'Emotion' and 'Sensation'. In the ‘Pain’ domain, only 7 (11%) out of 66 has occasional pain and discomfort.

Conclusion

Majority of PICU survivors(84%) have a good long term Quality of life (HUI mean score 0.94+/0.06).

Background

Management of SGA fetuses is underdebate, since induction of labor, elective cesarean section and expectant management have been proposed.

Objectives

The aim of this review was to analyze literature about neonatal outcomes of small for gestational age (SGA) after planned delivery versus expectant management.

Methods

By search in PubMed, EMBASE, Medline and reference list, studies were included if SGA was defined as birthweight <10th centile for gestational age (GA), SGA fetuses were alive at labor, planned delivery was compared with expectant management. Exclusion criteria: multiple pregnancies, congenital malformations, Doppler anomalies, data in graphs or percentage. Neonatal morbidity and neonatal mortality were abstracted from each article. Random effect model was generated if inter-studies heterogeneity was >25%. OddsRatio and 95%ConfidenceInterval (OR,95%CI) were calculated and defined significant if 95%CI did not encompass 1. PRISMA guidelines were followed.

Results

Out of 6519 SGA, 2552 (39.2%) and 3967 (60.8%) SGA underwent planned delivery and expectant management, respectively. Compared to expectant management, SGA with planned delivery were more likely to be affected with respiratory distress syndrome (OR:2.93;95%CI:2.543.40), sepsis (OR:2.21;95%CI:1.60-3.04), intraventricular hemorrhage/hypoxic-ischemic encephalopathy (OR:1.72;95%CI:1.252.37), seizures (OR:1.84;95%CI:0.84-4.00), 5-min Apgar<7 (OR:2.65;95%CI:2.04-3.44), neonatal death (OR:2.09;95%CI:1.45-3.01). No difference was noted with regard to admission to neonatal intensive care unit (OR:0.98;95%CI:0.71-1.34). Data about gestational age at delivery were scarce.

Conclusion

SGA fetuses without Doppler anomalies do not benefit of planned delivery, whereas expectant management is associated with a lower risk of neonatal adverse outcomes. Limitations of literature include the optimal gestational age at delivery, mode of delivery, and no randomization between planned delivery and expectant management.

Background

As PICU survival improves, long term functional outcome has evolved to be a vital benchmark for quality of paediatric critical care.

Objectives

This study aims to evaluate functional status of children after PICU admission and their recovery trajectory.

Methods

Patients aged one month to eighteen years old with longer than 24 hours PICU stay were included in the study. Death, absence of parental consent and/or inability to communicate for follow-up were excluded. We documented patients' clinical course of PICU stay, baseline function and functional status at PICU and hospital discharge using the Functional Status Scale (FSS); this was also used during follow-up at one, three and six months post hospital discharge via phone interview with the parents.

Results

116 patients were recruited within a six-month period; 75 of them (65%) completed the six months follow-up. Respiratory failure (42.2%) and neurological emergencies (19.8%) were the commonest causes of admission. Existing functional impairment was present in 21.6% of patients and chronic co-morbidities was in 47.4%. At hospital discharge, abnormal functional status was observed in 51.7% of patients; motor dysfunction being the commonest. New morbidity (increase in FSS of ≥ 3) was seen in 22% of patients. Recovery was most apparent at one-month follow-up and 9.3% of them persist to have new morbidity at six-month. Those with new morbidity had longer PICU-stay, ventilator-day and more common among patients without pre-existing co-morbidity.

Conclusion

New morbidity is common in children admitted into our PICU. Improvement is seen in majority of them within six months.

Background

Pediatric oncological patients admitted to the ICU have a higher mortality rates as compared to non-cancer patients especially for those requiring mechanical ventilation

Objectives

Objectives

To determine the incidence, admission characteristics and outcomes of pediatric cancer patients requiring mechanical ventilation in the ICU.

Methods

Methodology

This is a retrospective audit of all pediatric oncology patients requiring mechanical ventilation in the ICU between Nov 2014 and Oct 2015.

Inclusion Criteria

Patients < 18 years admitted to the ICU requiring Mechanical Ventilation

Exclusion Criteria

Bone marrow transplant patients

Results

Results

A total of 200 pediatric cancer patients were admitted to the ICU during the study period of which 81 were solid tumors and 119 were hematological patients .

The overall ICU mortality was 42.5%.

Solid tumor patients had significantly lower overall mortality as compared to hematological Patients (30.8%vs 50.4%) (P < 0.05)

Patients requiring mechanical ventilation were 78% with an ICU mortality of 52.6% and hospital mortality of 60.9%

Days of ventilation was significantly higher in survivors as compared to non survivors (p=0.031)

On multivariate analysis mechanical ventilation was an independent predictor of mortality (p=0.03) OR 14.637 (CI 1.298-165.05)

When Mechanical Ventilation was stratified according to hematologic malignancy and solid tumors, the mortality was 58.4% vs. 41.1% respectively ( p <0.05).

Conclusion

Conclusion

Children with hematologic cancer have significantly higher ICU mortality rates than children with solid tumors and need for mechanical ventilation remains a significant predictor of poor outcomes

Background

Since the civil war in Syria began, millions of Syrians have left the country and been forced to migrate to other countries. Turkey is the country with most migration hosting 3.6 million refugees.

Objectives

The aim of this study was to compare the PIM-3, PELOD-2, PELOD-2 PDR, mortality rates and outcomes of patients who were admitted to the pediatric intensive care unit.

Methods

This was a retrospective study performed between February 2018 and February 2019 at Hatay State Hospital, very close to the Syrian border. The study included 158 patients. Patients were divided into 3 groups as Turkish citizens, those living in Turkey as refugees and those brought from the border.

Results

Of patients, 57 were Turkish citizens, 33 were refugees and 68 were brought from the border. For patients, the mean PIM-3 score was 25.62±27.70, PELOD-2 score was 8.03±4.72 and PELOD2-PDR was 16.07±23.45. The median scores for PIM-3, PELOD-2, and PELOD2-PDR of patients brought from the Syrian border were evaluated to be higher compared to Turkish citizens and refugees. There was no significant difference observed between refugees and Turkish citizens(Table1). Of patients who died, 59.20% comprised patients brought from the border(Table2)

Conclusion

It is considered that the source of the difference between patients brought from the border and living within Turkey may be associated with the continuing war beyond our borders and children experiencing insufficient care conditions.

In conclusion, war doesn't just cause death due to weapons but also due to many different causes and unfortunately, children suffer most because of this situation.